Poster Session I – Poster of Distinction - A96 ADHERENCE TO PAST AND CONTEMPORARY POST-POLYPECTOMY SURVEILLANCE GUIDELINES

TL;DR

This study examines how well doctors followed updated guidelines for colonoscopy follow-up after removing polyps, finding that adherence is low for some patient groups.

Contribution

The study evaluates adherence to revised 2020 post-polypectomy surveillance guidelines compared to the 2012 guidelines across different patient risk categories.

Findings

Adherence to 2020 guidelines was low for patients with 1–2 small adenomas, with most still scheduled for 5-year follow-ups.

High-risk patients showed moderate adherence, but delayed follow-up was common among those with villous/tubulovillous adenomas.

Overall adherence was higher when follow-up intervals were shorter than recommended, suggesting continued reliance on older practices.

Abstract

United States MultiSociety TaskForce (USMSTF) guidelines addressing post-polypectomy colonoscopy intervals were issued in 2012 and modified in 2020.

Assess post-polypectomy surveillance intervals adherence to USMSTF 2012 and 2020 recommendations.

We included patients with a past personal or index colonoscopy history of colon polyps from two tertiary hospitals. Procedural reports were reviewed and patients stratified according to index colonoscopy findings into: normal colonoscopy, 1–2 small (<10 mm) adenomas, 3–4 small adenomas, 5–10 polyps, >10 polyps, ≥1 adenoma ≥10 mm, at least one adenoma with high grade dysplasia, or a serrated polyp with dysplasia, or a traditional serrated adenoma. Recommended follow-up intervals were classified as earlier, later or adherent to 2020 guidelines, and compared to 2012 recommendations.

Overall, 5,204 colonoscopies were included over 47 months. When the first follow-up index colonoscopy was normal (n = 963), adherence to follow-up was only 7.9% as per both guidelines, i.e.: 86.7% scheduled sooner than recommended (<10 years). For patients with 1–2 adenomas (<10 mm) (n = 2,388), adherence was 71.4% according to 2012 guidelines (5 years) but fell to 3.3% with 2020 recommendations (7-10 years); most patients were still assigned a 5-year follow-up (87.1%). For 3–4 small adenomas (<10 mm) (n = 505), adherence was 47.6% for 2020 guidelines (3-5 years). When >10 polyps were removed (n = 22), there was better compliance, with adherence rates of 86.4% according to 2012 guidelines (< 3 years) and 50.0% for the 2020 recommendations (1 year). For lesions requiring a 3-year surveillance interval common to both guideline era, adherence was 39.5% for polyps ≥10 mm, 22.9% for villous/tubulovillous histology with/without high grade dysplasia, 27.1% for adenoma with high grade dysplasia, 12.5% for sessile serrated polyps with dysplasia, and 15.4% for traditional serrated adenomas. All non-adherent recommendations suggested a colonoscopy sooner than the recommended intervals, except for those with villous/tubulovillous histology with or without dysplasia, among whom 55.7% were later than the recommended post-polypectomy colonoscopy intervals.

Continued practice according to earlier-surveillance interval persist, particularly for low-risk patients with a normal colonoscopy or 1–2 small adenomas, despite the revises 7–10 year extended interval recommendations in 2020. Adherence for high-risk findings was moderate and unchanged, while delayed follow-up was most frequent among patients with villous or tubulovillous adenomas. There is a need for improved implementation of societal recommendations to ensure optimal evidence-based surveillance practices in the face of what are often limited colonoscopy resources.

The study as been funded by the CPAC

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