Optimal resource allocation in colonoscopy: timing of follow-up colonoscopies in relation to adenoma detection rates

Endoscopy. 2013 Jul;45(7):545-52. doi: 10.1055/s-0032-1326359. Epub 2013 Apr 11.


Background and study aims: The assessment of indications for follow-up colonoscopy may help to improve the allocation of available endoscopy resources. The aim of this study was to assess the timing of early follow-up colonoscopy and surveillance utilization in relation to adenoma detection rate (ADR) at follow-up.

Methods: An assessment of the timing and yield of follow-up colonoscopies was performed in patients with non-inflammatory bowel disease (IBD) in a Dutch multicenter study. The primary outcome was the number of patients with a prior (index) colonoscopy. The necessity for follow-up procedures was assessed using the ADR.

Results: Of 4800 consecutive patients undergoing a colonoscopy, 1249 non-IBD patients had undergone an index colonoscopy. Of these, follow-up procedures were performed within 1 year in 27 % (331/1249). Excluding incomplete colonoscopy, incomplete polypectomy, or poor bowel preparation on index, the ADR on early follow-up was 4 % for symptomatic and 26 % for asymptomatic patients. Among the asymptomatic patients with a follow-up colonoscopy at > 1 year (n = 463), an ADR of 23 % (108/463) was found. In 27 % of these patients, the observed surveillance intervals were in accordance with American Gastroenterological Association (AGA) surveillance recommendations; 60 % were classified as over-utilization and 13 % as under-utilization according to the AGA. Optimal utilization follow-up colonoscopies had higher ADRs on follow-up compared with over-utilized procedures (31 % vs. 17 %; P < 0.001).

Conclusions: Follow-up colonoscopy in symptomatic patients within a year has limited value in terms of adenoma detection. A considerable proportion of surveillance colonoscopies are performed too early according to current guidelines, resulting in low detection rates. Both aspects can be targeted for optimal usage in endoscopic capacity.

Publication types

  • Evaluation Study
  • Multicenter Study

MeSH terms

  • Adenoma / diagnosis*
  • Aged
  • Asymptomatic Diseases
  • Colonoscopy / statistics & numerical data*
  • Colorectal Neoplasms / diagnosis*
  • Female
  • Follow-Up Studies
  • Guideline Adherence / statistics & numerical data*
  • Humans
  • Male
  • Middle Aged
  • Netherlands
  • Practice Guidelines as Topic
  • Resource Allocation / statistics & numerical data*
  • Retrospective Studies
  • Time Factors