Recommendations for Post-Polypectomy Surveillance in Community Practice
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After colon cancer screening, large numbers of persons discovered with colon polyps may receive post-polypectomy surveillance with multiple colonoscopy examinations over time. Decisions about surveillance interval are based in part on polyp size, histology, and number.
To learn physicians’ recommendations for post-polypectomy surveillance from physicians’ office charts.
Among 322 physicians performing colonoscopy in 126 practices in N. Carolina, offices of 152 physicians in 55 practices were visited to extract chart data, for each physician, on 125 consecutive persons having colonoscopy in 2003. Subjects included persons with first-time colonoscopy and no positive family history or other indication beyond colonoscopy findings that might affect post-polypectomy surveillance recommendations. Data were extracted about demographics, reason for colonoscopy, family history, symptoms, bowel prep, extent of examination, and features of each polyp including location, size, histology. Recommendations for post-polypectomy surveillance were noted.
Among 10,089 first-time colonoscopy examinations, hyperplastic polyps were found in 4.5% of subjects, in whom follow-up by 4–6 years was recommended in 24%, sooner than recommended in guidelines. Of the 6.6% of persons with only small adenomas, 35% were recommended to return in 1–3 years (sooner than recommended in some guidelines) and 77% by 6 years. Surveillance interval tended to be shorter if colon prep was less than “excellent.” Prep quality was not reported for 32% of examinations.
Surveillance intervals after polypectomy of low-risk polyps may be more aggressive than guidelines recommend. The quality of post-polypectomy surveillance might be improved by increased attention to guidelines, bowel prep, and reporting.
- Lieberman DA, Weiss DG, Bond JH, et al. Use of colonoscopy to screen asymptomatic adults for colorectal cancer. N Engl J Med. 2000;343:162–168. CrossRef
- Imperiale TF, Wagner DR, Lin CY, Larkin GN, Rogge JD, Ransohoff DF. Risk of advanced proximal neoplasms in asymptomatic adults according to the distal colorectal findings. N Engl J Med. 2000;343:169–174. CrossRef
- Atkin WA. UK flexible sigmoidoscopy screening trial investigators. Single flexible sigmoidoscopy screening to prevent colorectal cancer: Baseline findings of a UK multicentre randomised trial. Lancet. 2002;359:1291–1300. CrossRef
- Vatn MH, Stalsberg H. The prevalence of polyps of the large intestine in Oslo: An autopsy study. Cancer. 1982;49:819–825. CrossRef
- Williams AR, Balasooriya BA, Day DW. Polyps and cancer of the large bowel: a necropsy study in Liverpool. Gut. 1982;23:835–842. CrossRef
- Rex DK, Lieberman DA. Feasibility of colonoscopy screening: Discussion of issues and recommendations regarding implementation. Gastrointest Endosc. 2001;54:662–667. CrossRef
- Harewood GC, Lieberman DA. Colonoscopy practice patterns since introduction of medicare coverage for average-risk screening. Clin Gastroenterol Hepatol. 2004;2:72–77. CrossRef
- Maguire P. Colonoscopy screening gains momentum, but problems remain. ACP-ASIM Obs. 2002;22:16–17.
- Rosson RS, Spiro HM. Screening for colorectal cancer. Ann Intern Med. 2003;138:356–357; author reply 357.
- Kolata G. 50 and ready for a colonoscopy? Doctors say there is often a wait. New York Times, December 8, 2003. Sect. A1, A23.
- Laiyemo AO, Pinsky PF, Marcus PM, et al. Utilization and yield of surveillance colonoscopy in the continued follow-up study of the polyp prevention trial. Clin Gastroenterol Hepatol. 2009;7:562–567; quiz 497.
- Boolchand V, Olds G, Singh J, Singh P, Chak A, Cooper GS. Colorectal screening after polypectomy: a national survey study of primary care physicians. Ann Intern Med. 2006;145:654–659.
- Winawer SJ, Fletcher RH, Miller L, et al. Colorectal cancer screening: clinical guidelines and rationale. Gastroenterology. 1997;112:594–642. CrossRef
- Winawer S, Fletcher R, Rex D, et al. Colorectal cancer screening and surveillance: Clinical guidelines and rationale-update based on new evidence. Gastroenterology. 2003;124:544–560. CrossRef
- Levin B, Lieberman DA, McFarland B, et al. Screening and surveillance for the early detection of colorectal cancer and adenomatous polyps, 2008: a joint guideline from the American Cancer Society, the US Multi-Society Task Force on Colorectal Cancer, and the American College of Radiology. CA Cancer J Clin. 2008;58:130–160. CrossRef
- Ransohoff DF. Colon cancer screening in 2005: Status and challenges. Gastroenterology. 2005;128:1685–1695. CrossRef
- Mysliwiec PA, Brown ML, Klabunde CN, Ransohoff DF. Are physicians doing too much colonoscopy? A national survey of colorectal surveillance after polypectomy. Ann Intern Med. 2004;141:264–271.
- Schoen RE, Pinsky PF, Weissfeld JL, et al. Utilization of surveillance colonoscopy in community practice. Gastroenterology. 2010;138:73–81. CrossRef
- American Society for Gastrointestinal Endoscopy. Colonoscopy in the screening and surveillance of individuals at increased risk for colorectal cancer. Manchester, MA 01944; 1997 ASGE Publication No. 1030.
- Bond JH. Polyp guideline: diagnosis, treatment, and surveillance for patients with colorectal polyps. Practice parameters committee of the American College of Gastroenterology. Am J Gastroenterol. 2000;95:3053–3063. CrossRef
- Smith RA, von Eschenbach AC, Wender R, et al. American cancer society guidelines for the early detection of cancer: Update of early detection guidelines for prostate, colorectal, and endometrial cancers. CA CA Cancer J Clin. 2001;51:38–75. CrossRef
- Bond JH. For the practice parameters committee of the American College of Gastroenterology. Polyp guideline: Diagnosis, treatment, and surveillance for patients with nonfamilial colorectal polyps. The practice parameters committee of the American College of Gastroenterology. Ann Intern Med. 1993;119:836–843.
- Winawer SJ, Zauber AG, Fletcher RH, et al. Guidelines for colonoscopy surveillance after polypectomy: A consensus update by the US multi-society task force on colorectal cancer and the American cancer society. Gastroenterology. 2006;130:1872–1885. CrossRef
- Hewett DG, Rex DK. Improving colonoscopy quality through health-care payment reform. Am J Gastroenterol. 2010;105:1925–1933. CrossRef
- Laiyemo AO, Murphy G, Albert PS, et al. Postpolypectomy colonoscopy surveillance guidelines: predictive accuracy for advanced adenoma at 4 years. Ann Intern Med. 2008;148:419–426.
- Ransohoff DF, McNaughton Collins M, Fowler FJ. Why is prostate cancer screening so common when the evidence is so uncertain? A system without negative feedback. Am J Med. 2002;113:663–667. CrossRef
- Soetikno RM, Kaltenbach T, Rouse RV, et al. Prevalence of nonpolypoid (flat and depressed) colorectal neoplasms in asymptomatic and symptomatic adults. JAMA. 2008;299:1027–1035. CrossRef
- Baxter NN, Goldwasser MA, Paszat LF, Saskin R, Urbach DR, Rabeneck L. Association of colonoscopy and death from colorectal cancer. Ann Intern Med. 2009;150:1–8.
- Ransohoff DF. How much does colonoscopy reduce colon cancer mortality? Ann Intern Med. 2009;150:50–52.
- Barclay RL, Vicari JJ, Doughty AS, Johanson JF, Greenlaw RL. Colonoscopic withdrawal times and adenoma detection during screening colonoscopy. N Engl J Med. 2006;355:2533–2541. CrossRef
- Atkin WS, Edwards R, Kralj-Hans I, et al. Once-only flexible sigmoidoscopy screening in prevention of colorectal cancer: A multicentre randomised controlled trial. Lancet. 2010;375:1624–1633. CrossRef
- Recommendations for Post-Polypectomy Surveillance in Community Practice
Digestive Diseases and Sciences
Volume 56, Issue 9 , pp 2623-2630
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- Colonoscopy screening
- Colon cancer surveillance
- Colonoscopy guidelines
- Colonoscopy quality
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- Author Affiliations
- 1. Departments of Medicine and Epidemiology, CB 7080, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599-7080, USA
- 2. CB 7510, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599-7510, USA
- 3. CB 7426, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599-7426, USA
- 4. CB 7080, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599-7080, USA