Recommendations for Post-Polypectomy Surveillance in Community Practice
Rent the article at a discountRent now
* Final gross prices may vary according to local VAT.Get Access
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 (2000) Use of colonoscopy to screen asymptomatic adults for colorectal cancer. N Engl J Med 343: pp. 162-168 CrossRef
- Imperiale, TF, Wagner, DR, Lin, CY, Larkin, GN, Rogge, JD, Ransohoff, DF (2000) Risk of advanced proximal neoplasms in asymptomatic adults according to the distal colorectal findings. N Engl J Med 343: pp. 169-174 CrossRef
- Atkin, WA (2002) UK flexible sigmoidoscopy screening trial investigators. Single flexible sigmoidoscopy screening to prevent colorectal cancer: Baseline findings of a UK multicentre randomised trial. Lancet 359: pp. 1291-1300 CrossRef
- Vatn, MH, Stalsberg, H (1982) The prevalence of polyps of the large intestine in Oslo: An autopsy study. Cancer 49: pp. 819-825 CrossRef
- Williams, AR, Balasooriya, BA, Day, DW (1982) Polyps and cancer of the large bowel: a necropsy study in Liverpool. Gut 23: pp. 835-842 CrossRef
- Rex, DK, Lieberman, DA (2001) Feasibility of colonoscopy screening: Discussion of issues and recommendations regarding implementation. Gastrointest Endosc 54: pp. 662-667 CrossRef
- Harewood, GC, Lieberman, DA (2004) Colonoscopy practice patterns since introduction of medicare coverage for average-risk screening. Clin Gastroenterol Hepatol 2: pp. 72-77 CrossRef
- Maguire, P (2002) Colonoscopy screening gains momentum, but problems remain. ACP-ASIM Obs 22: pp. 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 (2006) Colorectal screening after polypectomy: a national survey study of primary care physicians. Ann Intern Med 145: pp. 654-659
- Winawer, SJ, Fletcher, RH, Miller, L (1997) Colorectal cancer screening: clinical guidelines and rationale. Gastroenterology 112: pp. 594-642 CrossRef
- Winawer, S, Fletcher, R, Rex, D (2003) Colorectal cancer screening and surveillance: Clinical guidelines and rationale-update based on new evidence. Gastroenterology 124: pp. 544-560 CrossRef
- Levin, B, Lieberman, DA, McFarland, B (2008) 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 58: pp. 130-160 CrossRef
- Ransohoff, DF (2005) Colon cancer screening in 2005: Status and challenges. Gastroenterology 128: pp. 1685-1695 CrossRef
- Mysliwiec, PA, Brown, ML, Klabunde, CN, Ransohoff, DF (2004) Are physicians doing too much colonoscopy? A national survey of colorectal surveillance after polypectomy. Ann Intern Med 141: pp. 264-271
- Schoen, RE, Pinsky, PF, Weissfeld, JL (2010) Utilization of surveillance colonoscopy in community practice. Gastroenterology 138: pp. 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 (2000) Polyp guideline: diagnosis, treatment, and surveillance for patients with colorectal polyps. Practice parameters committee of the American College of Gastroenterology. Am J Gastroenterol 95: pp. 3053-3063 CrossRef
- Smith, RA, Eschenbach, AC, Wender, R (2001) 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 51: pp. 38-75 CrossRef
- Bond, JH (1993) 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 119: pp. 836-843
- Winawer, SJ, Zauber, AG, Fletcher, RH (2006) 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 130: pp. 1872-1885 CrossRef
- Hewett, DG, Rex, DK (2010) Improving colonoscopy quality through health-care payment reform. Am J Gastroenterol 105: pp. 1925-1933 CrossRef
- Laiyemo, AO, Murphy, G, Albert, PS (2008) Postpolypectomy colonoscopy surveillance guidelines: predictive accuracy for advanced adenoma at 4 years. Ann Intern Med 148: pp. 419-426
- Ransohoff, DF, McNaughton Collins, M, Fowler, FJ (2002) Why is prostate cancer screening so common when the evidence is so uncertain? A system without negative feedback. Am J Med 113: pp. 663-667 CrossRef
- Soetikno, RM, Kaltenbach, T, Rouse, RV (2008) Prevalence of nonpolypoid (flat and depressed) colorectal neoplasms in asymptomatic and symptomatic adults. JAMA 299: pp. 1027-1035 CrossRef
- Baxter, NN, Goldwasser, MA, Paszat, LF, Saskin, R, Urbach, DR, Rabeneck, L (2009) Association of colonoscopy and death from colorectal cancer. Ann Intern Med 150: pp. 1-8
- Ransohoff, DF (2009) How much does colonoscopy reduce colon cancer mortality?. Ann Intern Med 150: pp. 50-52
- Barclay, RL, Vicari, JJ, Doughty, AS, Johanson, JF, Greenlaw, RL (2006) Colonoscopic withdrawal times and adenoma detection during screening colonoscopy. N Engl J Med 355: pp. 2533-2541 CrossRef
- Atkin, WS, Edwards, R, Kralj-Hans, I (2010) Once-only flexible sigmoidoscopy screening in prevention of colorectal cancer: A multicentre randomised controlled trial. Lancet 375: pp. 1624-1633 CrossRef
- Recommendations for Post-Polypectomy Surveillance in Community Practice
Digestive Diseases and Sciences
Volume 56, Issue 9 , pp 2623-2630
- Cover Date
- Print ISSN
- Online ISSN
- Springer US
- Additional Links
- Colonoscopy screening
- Colon cancer surveillance
- Colonoscopy guidelines
- Colonoscopy quality
- Industry Sectors
- 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