Bowel Prep Quality May Affect Surveillance Intervals

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Following screening for colon cancer, those individuals found to have colon polyps may receive post-polypectomy surveillance, with multiple colonoscopy examinations carried out over time.
Decisions regarding the surveillance interval are based in part on polyp size, histology, and number.

Dr David Ransohoff and colleagues in the USA, evaluated a number of recommendations for post-polypectomy surveillance. The subjects under review included those who had undergone their first colonoscopy and had no positive family history or other indication beyond colonoscopy findings that might affect post-polypectomy surveillance recommendations.

Among 322 physicians performing colonoscopy in 126 practices in North Carolina, USA, the offices of 152 physicians in 55 practices were visited to extract patient data, for each physician, on 125 consecutive patients having colonoscopy in 2003.

The team extracted data about demographics, reason for colonoscopy, family history, symptoms, bowel prep, extent of examination, and features of each polyp including location, size, histology. The recommendations for post-polypectomy surveillance were also noted.

Among 10,089 first-time colonoscopy examinations, hyperplastic polyps were found in 5% of subjects, in whom follow-up by 4–6 years was recommended in 24%, sooner than recommended in guidelines.

Of the 7% of persons with only small adenomas, the team found that 35% were recommended to return in 1–3 years, and 77% by 6 years.

The research team observed that the surveillance interval tended to be shorter if colon prep was less than ‘excellent’.

Prep quality was not reported for 32% of examinations.

Dr Ransohoff’s team concluded, “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.”

Prime Endoscopy Bristol is a community based endoscopy service