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van Heijningen EM, Lansdorp-Vogelaar I, Steyerberg EW, et al. Adherence to surveillance guidelines after removal of colorectal adenomas: a large, community-based study. Gut. 2015;64(10):1584-92doi: 10.1136/gutjnl-2013-306453.
van Heijningen, E. M., Lansdorp-Vogelaar, I., Steyerberg, E. W., Goede, S. L., Dekker, E., Lesterhuis, W., ter Borg, F., Vecht, J., Spoelstra, P., Engels, L., Bolwerk, C. J., Timmer, R., Kleibeuker, J. H., Koornstra, J. J., de Koning, H. J., Kuipers, E. J., & van Ballegooijen, M. (2015). Adherence to surveillance guidelines after removal of colorectal adenomas: a large, community-based study. Gut, 64(10), 1584-92. https://doi.org/10.1136/gutjnl-2013-306453
van Heijningen, Else-Mariëtte B, et al. "Adherence to surveillance guidelines after removal of colorectal adenomas: a large, community-based study." Gut vol. 64,10 (2015): 1584-92. doi: https://doi.org/10.1136/gutjnl-2013-306453
van Heijningen EM, Lansdorp-Vogelaar I, Steyerberg EW, Goede SL, Dekker E, Lesterhuis W, ter Borg F, Vecht J, Spoelstra P, Engels L, Bolwerk CJ, Timmer R, Kleibeuker JH, Koornstra JJ, de Koning HJ, Kuipers EJ, van Ballegooijen M. Adherence to surveillance guidelines after removal of colorectal adenomas: a large, community-based study. Gut. 2015 Oct;64(10):1584-92. doi: 10.1136/gutjnl-2013-306453. Epub 2015 Jan 13. PMID: 25586057; PMCID: PMC4602240.
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Gut. 2015 Oct;64(10):1584-92. doi: 10.1136/gutjnl-2013-306453. Epub 2015 Jan 13.

Adherence to surveillance guidelines after removal of colorectal adenomas: a large, community-based study.

Gut

Else-Mariëtte B van Heijningen, Iris Lansdorp-Vogelaar, Ewout W Steyerberg, S Lucas Goede, Evelien Dekker, Wilco Lesterhuis, Frank ter Borg, Juda Vecht, Pieter Spoelstra, Leopold Engels, Clemens J M Bolwerk, Robin Timmer, Jan H Kleibeuker, Jan J Koornstra, Harry J de Koning, Ernst J Kuipers, Marjolein van Ballegooijen

Affiliations

  1. Department of Public Health, Erasmus MC University Medical Centre, Rotterdam, the Netherlands.
  2. Department of Gastroenterology and Hepatology, Academic Medical Centre, University of Amsterdam, Amsterdam, the Netherlands.
  3. Department of Gastroenterology and Hepatology, Erasmus MC University Medical Centre, Rotterdam, the Netherlands Department of Gastroenterology, Albert Schweitzer hospital, Dordrecht, the Netherlands.
  4. Department of Gastroenterology and Hepatology, Deventer Hospital, Deventer, the Netherlands.
  5. Department of Gastroenterology and Hepatology, Isala Clinics, Zwolle, the Netherlands.
  6. Department of Gastroenterology and Hepatology, Medical Centre Leeuwarden, Leeuwarden, the Netherlands.
  7. Department of Gastroenterology and Hepatology, Orbis Medical Centre, Sittard, the Netherlands.
  8. Department of Gastroenterology and Hepatology, Reinier de Graaf Hospital, Delft, the Netherlands.
  9. Department of Gastroenterology and Hepatology, St. Antonius Hospital, Nieuwegein, the Netherlands.
  10. Department of Gastroenterology, University Medical Centre Groningen, University of Groningen, Groningen, the Netherlands.
  11. Department of Gastroenterology and Hepatology, Erasmus MC University Medical Centre, Rotterdam, the Netherlands Department of Internal Medicine, Erasmus MC University Medical Centre, Rotterdam, the Netherlands.

PMID: 25586057 PMCID: PMC4602240 DOI: 10.1136/gutjnl-2013-306453

Abstract

OBJECTIVE: To determine adherence to recommended surveillance intervals in clinical practice.

DESIGN: 2997 successive patients with a first adenoma diagnosis (57% male, mean age 59 years) from 10 hospitals, who underwent colonoscopy between 1998 and 2002, were identified via Pathologisch Anatomisch Landelijk Geautomatiseerd Archief: Dutch Pathology Registry. Their medical records were reviewed until 1 December 2008. Time to and findings at first surveillance colonoscopy were assessed. A surveillance colonoscopy occurring within ± 3 months of a 1-year recommended interval and ± 6 months of a recommended interval of 2 years or longer was considered appropriate. The analysis was stratified by period per change in guideline (before 2002: 2-3 years for patients with 1 adenoma, annually otherwise; in 2002: 6 years for 1-2 adenomas, 3 years otherwise). We also assessed differences in adenoma and colorectal cancer recurrence rates by surveillance timing.

RESULTS: Surveillance was inappropriate in 76% and 89% of patients diagnosed before 2002 and in 2002, respectively. Patients eligible under the pre-2002 guideline mainly received surveillance too late or were absent (57% of cases). For patients eligible under the 2002 guideline surveillance occurred mainly too early (48%). The rate of advanced neoplasia at surveillance was higher in patients with delayed surveillance compared with those with too early or appropriate timed surveillance (8% vs 4-5%, p<0.01).

CONCLUSIONS: There is much room for improving surveillance practice. Less than 25% of patients with adenoma receive appropriate surveillance. Such practice seriously hampers the effectiveness and efficiency of surveillance, as too early surveillance poses a considerable burden on available resources while delayed surveillance is associated with an increased rate of advanced adenoma and especially colorectal cancer.

Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Keywords: COLONOSCOPY; COLORECTAL ADENOMAS; ENDOSCOPIC POLYPECTOMY; SURVEILLANCE

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