Applying evidence-based guidelines improves use of colonoscopy resources in patients with a moderate risk of colorectal neoplasia

Med J Aust. 2002 Feb 18;176(4):155-7. doi: 10.5694/j.1326-5377.2002.tb04344.x.


Objectives: To determine whether applying National Health and Medical Research Council (NHMRC) guidelines for colorectal cancer prevention would reduce the number of follow-up colonoscopies.

Design: A prospective audit of colonoscopic surveillance decisions before and after the intervention.

Setting: The endoscopy suite at a metropolitan tertiary hospital three months before and after January 2000.

Intervention: Dissemination of NHMRC guidelines, and supervision of application of the guidelines by a nurse coordinator.

Subjects: We compared colonoscopic surveillance decisions before and after the intervention in two groups of 100 consecutive patients after polypectomy and in two groups of 50 consecutive patients with a family history of colorectal cancer after a normal colonoscopy.

Main outcome measures: Change in concordance of decisions with NHMRC guidelines; and effect on number of follow-up colonoscopies.

Results: After the intervention, the proportion of postpolypectomy surveillance decisions matching the guidelines increased from 37% to 96% (P < 0.05). The mean time to repeat colonoscopy after polypectomy increased from 2.7 to 3.5 years (P < 0.005) (ie, a 23% reduction in the number of postpolypectomy surveillance colonoscopies performed per year). Likewise, the proportion of family-history surveillance decisions matching the guidelines increased from 63% to 96%. Adhering to the guidelines resulted in a 17% reduction in colonoscopies performed on the basis of a family history of colorectal cancer.

Conclusions: Supervised application of evidence-based guidelines to a colorectal cancer surveillance program significantly reduces the number of surveillance colonoscopies performed.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adenoma / surgery
  • Australia
  • Colonic Polyps / surgery
  • Colonoscopy* / statistics & numerical data
  • Colorectal Neoplasms / genetics
  • Colorectal Neoplasms / prevention & control*
  • Evidence-Based Medicine*
  • Female
  • Guideline Adherence*
  • Humans
  • Male
  • Medical Audit
  • Middle Aged
  • Practice Guidelines as Topic / standards*
  • Prospective Studies
  • Risk Factors
  • Time Factors