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Recommendations for Post-Polypectomy Surveillance in Community Practice

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Abstract

Background

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.

Aims

To learn physicians’ recommendations for post-polypectomy surveillance from physicians’ office charts.

Methods

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.

Results

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.

Conclusions

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.

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Acknowledgments

Thanks to Tara Adams, Elizabeth Rolfe-Hill, and Nabeel Barakat for their role in acquisition of data and project support. Thanks to our project advisory group: Eugene Bozymski MD, Steve Deal MD, John Gilliam MD, Mark Koruda MD, John Poulos MD, and Tom Swantkowski MD. Thanks also to Bob Blake, director of North Carolina Advisory Council for Gastrointestinal Endoscopy.

Grant support

National Cancer Institute 1R01CA104950.

Disclosures

None.

Author information

Authors and Affiliations

  1. Departments of Medicine and Epidemiology, CB 7080, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599-7080, USA

    David F. Ransohoff

  2. CB 7510, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599-7510, USA

    Bonnie Yankaskas

  3. CB 7426, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599-7426, USA

    Ziya Gizlice

  4. CB 7080, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599-7080, USA

    Lisa Gangarosa

Authors
  1. David F. Ransohoff
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  2. Bonnie Yankaskas
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  3. Ziya Gizlice
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  4. Lisa Gangarosa
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Correspondence to David F. Ransohoff.

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Ransohoff, D.F., Yankaskas, B., Gizlice, Z. et al. Recommendations for Post-Polypectomy Surveillance in Community Practice. Dig Dis Sci 56, 2623–2630 (2011). https://doi.org/10.1007/s10620-011-1791-y

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  • DOI: https://doi.org/10.1007/s10620-011-1791-y

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