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Guidelines versus real life practice: the case of colonoscopy in acromegaly

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Abstract

Purpose

The aim of this study is to investigate guideline application and colonoscopy findings in real-life practice in acromegaly.

Methods

We conducted a retrospective observational non-interventional and cross-sectional analysis on 146 patients with acromegaly (ACRO) referred to our clinic. We evaluated colonoscopy data, focusing on the correlation between colonoscopy findings and hormonal/metabolic values.

Results

The total number of colonoscopies performed in ACRO patients increased from 6 in the period 1990–1994 to 57 in the period 2010–2014. Colonoscopy procedures were performed according to guidelines in 25% of ACRO patients at diagnosis, 51% at follow-up and 11% globally (both at diagnosis and follow-up). Among the 146 ACRO patients, 68% were subjected to at least one colonoscopy and in 32% of the cases a polyp was detected during the procedure. The presence of polyps was significantly associated with mean levels of growth hormone (GH), insulin-like growth factor 1 (IGF-1), fasting glucose and insulin levels (p < 0.05). Polyps were detected in 48% of untreated patients and in 26% of patients under treatment for acromegaly (p = 0.04). The general risk of polyps and adenomatous polyps in ACRO patients was higher compared to the control population of Veneto Region, Italy (odds ratio 1.33 and 1.16, respectively). No cancerous polyps were detected in our analysis.

Conclusion

In real-life practice, adherence to ACRO colonoscopy clinical guidelines was lower than expected. Among patients who underwent colonoscopy, the prevalence of colon polyps was higher for ACRO patients, suggesting the need for new strategies to ensure adherence to colonoscopy guidelines.

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Acknowledgements

Editorial assistance for the preparation of this manuscript was provided by Ambra Corti and Luca Giacomelli, PhD, on behalf of Content Ed Net; this assistance was funded by Novartis.

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Authors and Affiliations

  1. Department of Medicine (DIMED), Padua University Hospital, via Giustiniani 2, 35128, Padua, Italy

    M. Parolin, F. Dassie, L. Russo, S. Mazzocut, M. Ferrata, E. De Carlo, R. Mioni, F. Fallo, R. Vettor, C. Martini & P. Maffei

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  1. M. Parolin
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  2. F. Dassie
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  3. L. Russo
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  4. S. Mazzocut
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  6. E. De Carlo
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  7. R. Mioni
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  10. C. Martini
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  11. P. Maffei
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Corresponding author

Correspondence to M. Parolin.

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Conflict of interest

Dr Maffei has received unrestricted grants from Novartis, Pfizer and Ipsen and is member of Novartis, Italfarmaco, Pfizer and Ipsen advisory board. No financial support was provided for this study.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.

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Parolin, M., Dassie, F., Russo, L. et al. Guidelines versus real life practice: the case of colonoscopy in acromegaly. Pituitary 21, 16–24 (2018). https://doi.org/10.1007/s11102-017-0841-7

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  • DOI: https://doi.org/10.1007/s11102-017-0841-7

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