Awareness of Postpolypectomy Surveillance Guidelines: A Nationwide Survey of Colonoscopists in Canada
Several studies have demonstrated that screening asymptomatic, average-risk individuals and those at increased risk can reduce colorectal cancer mortality. Adherence to postpolypectomy surveillance guidelines becomes increasingly important amid the increasing demands for colonoscopy because suboptimal compliance can lead to unnecessary risks and the ineffective use of resources. However, performing too many surveillance colonoscopies, or at intervals that are too short, may hinder access to endoscopic procedures and decrease the cost effectiveness of colorectal cancer screening programs. Two reasons appear to be primarily responsible for nonadherence to postpolypectomy guidelines: lack of awareness or familiarity, and disagreement with the guidelines. Accordingly, this study aimed to determine the awareness of postpolypectomy guidelines among members of the Canadian Association of Gastroenterology, and the factors associated with physicians’ choices to deviate from them.INTRODUCTION: Due to the increasing demand for colonoscopy, adherence to postpolypectomy surveillance guidelines is important. Suboptimal compliance can lead to unnecessary risks and ineffective use of resources.OBJECTIVE: To determine the awareness of and adherence to postpolypectomy surveillance guidelines among members of the Canadian Association of Gastroenterology (CAG).METHODS: A survey describing 14 clinical cases was mailed to all physician members (n=411) of the CAG. Respondents were required to recommend a surveillance interval and a reason for his or her choice.RESULTS: A total of 150 colonoscopists (37%) completed the survey. Adherence to the guidelines varied from 23% to 96% per clinical scenario (median 63%). Recommended surveillance intervals were too short in 0% to 60% of the different cases (median 8%). The recommended interval was most often (60%) too short for a patient with one tubular adenoma with high-grade dysplasia. Surveillance intervals were too long in 4% to 75% of the cases (median 9%). The recommended interval was most often too long in a patient with a villous adenoma 15 mm in size and removed piecemeal (75%). Most often, recommendations were reported to be based on guidelines (median 74%; range 31% to 94%). However, in nine of 14 cases, more than 10% (median 18%; range 12% to 38%) of the respondents stated that their recommendation was based on guidelines, but did not provide the appropriate surveillance interval.CONCLUSIONS: Compliance to colonoscopy surveillance guidelines is suboptimal and reflects both overuse and underuse. The results show that awareness about the content of guidelines needs to be raised and strategies implemented to increase adherence.