Factors associated with adherence to the recommended postpolypectomy surveillance interval

• DOI: 10.1007/s00464-011-2094-2
• Publication Date: 2012-03-22T23:28:12Z
• Authors: Eun Ran Kim; Dong Hyun Sinn; Jin Yong Kim; Dong Kyung Chang; Poong-Lyul Rhee; Jae J. Kim; Jong Chul Rhee; Young-Ho Kim
• Keywords: Adult; Male; Delayed Diagnosis; Attitude of Health Personnel; Middle Aged; 3. Good health; Young Adult; 03 medical and health sciences; 0302 clinical medicine; Adenomatous Polyposis Coli; Practice Guidelines as Topic; Humans; Female; Clinical Competence; Guideline Adherence; Prospective Studies; Diagnostic Errors; Colorectal Neoplasms; Colorectal Surgery; Precancerous Conditions; Early Detection of Cancer; Aged

Appropriate surveillance intervals are important to ensure that the benefits of surveillance are not offset by harm. This study aimed to determine the factors associated with nonadherence to recommended colonoscopic surveillance intervals.The study enrolled 296 patients who underwent screening colonoscopy. The colonoscopies were performed by four endoscopists in the first or second year of fellowship. After each procedure, the endoscopists responded to a questionnaire that elicited information on the degree of concern for missed polyps (using a visual analog scale [VAS]), colonoscopic technical factors, and surveillance intervals.Of the 296 patients, 105 (36%) were adherent and 191 (64%) and were nonadherent to the guidelines. There were no differences in insertion time, withdrawal time, or polyp detection rate between the adherence and nonadherence groups. The endoscopy at cecal intubation was longer in the nonadherence group than in the adherence group (P = 0.013). The proportion of patients with poor bowel preparation was higher in the nonadherence group than in the adherence group (P = 0.011). The endoscopist's concern for missed polyps was greater in the nonadherence group than in the adherence group (P < 0.001). Based on multivariate analysis, only the endoscopist's concern was an independent factor associated with adherence to guidelines (P = 0.008). Poor bowel preparation, loop formation, and colonoscopy experience were independent factors associated with a high concern for missed polyps.Nonadherence to the recommended guidelines was associated with the endoscopist's concern for missed polyps. Improving colonoscopic skills and bowel preparation may decrease nonadherence to the recommended postpolypectomy surveillance interval.