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, 138 (1), 73-81

Utilization of Surveillance Colonoscopy in Community Practice

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Utilization of Surveillance Colonoscopy in Community Practice

Robert E Schoen et al. Gastroenterology.

Abstract

Background & aims: The recommended timing of surveillance colonoscopy for individuals with adenomatous polyps is based on adenoma histology, size, and number. The burden and cost of surveillance colonoscopy are significant. The aim of this study was to examine the use of surveillance colonoscopy on a community-wide basis.

Methods: We retrospectively queried participants in the Prostate, Lung, Colorectal, and Ovarian Cancer screening trial in 9 US communities about use of surveillance colonoscopy. Subjects whose initial colonoscopy showed advanced adenoma (AA), nonadvanced adenoma (NAA), or no adenoma (NA) findings were included. Colonoscopy examinations were confirmed by reviewing colonoscopy reports.

Results: Of 3876 subjects selected for inquiry, 3627 (93.6%) responded. The cumulative probability of a surveillance colonoscopy within 5 years was 58.4% (n = 1342) in the AA group, 57.5% in those with >or=3 NAAs (n = 117), 46.7% in those with 1-2 NAAs (n = 905), and 26.5% (n = 1263) in subjects with NAs. Within 7 years, 33.2% of subjects with AAs received >or=2 surveillance examinations versus 26.9% for those with >or=3 NAAs, 18.2% for those with 1 or 2 NAAs, and 10.4% for those with NAs. Incomplete colonoscopy, family history of colorectal cancer, or interval adenomatous findings could explain only a minority of surveillance colonoscopy in low-risk subjects.

Conclusions: In community practice, there is substantial overuse of surveillance colonoscopy among low-risk subjects and underuse among subjects with AAs. Interventions to better align use of surveillance colonoscopy with risk for advanced lesions are needed.

Conflict of interest statement

There are no conflicts of interest reported by the authors relevant to this manuscript. The investigators had full access to all of the data and take responsibility for the integrity of the data and the accuracy of the data analysis.

Figures

Figure 1
Figure 1
Kaplan-Meier probability curve for surveillance colonoscopy use by year from baseline diagnostic colonoscopy for subjects with Advanced Adenoma (Solid Line), ≥3 Non-advanced Adenoma (dotted line), 1-2 Non-advanced Adenoma (dashed line), and no adenoma (thin line).
Figure 2
Figure 2. Surveillance Colonoscopy Use by Baseline Histologic Status
CRC = Colorectal Cancer, AA= advanced adenoma, NAA=non-advanced adenoma, NA= no adenoma. The pathways on the far right demonstrate utilization in the subgroup without a family history of CRC, with complete, adequate colonoscopy, and without symptoms.
Figure 2
Figure 2. Surveillance Colonoscopy Use by Baseline Histologic Status
CRC = Colorectal Cancer, AA= advanced adenoma, NAA=non-advanced adenoma, NA= no adenoma. The pathways on the far right demonstrate utilization in the subgroup without a family history of CRC, with complete, adequate colonoscopy, and without symptoms.

Comment in

  • Community colonoscopy: a gordian knot?
    Allen JI. Allen JI. Gastroenterology. 2010 Jan;138(1):27-30. doi: 10.1053/j.gastro.2009.11.035. Epub 2009 Nov 21. Gastroenterology. 2010. PMID: 19932659 No abstract available.

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