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Showing content from http://www.ncbi.nlm.nih.gov/pubmed/19818779 below:

Utilization of surveillance colonoscopy in community practice

Affiliations

• ¹ Department of Medicine, University of Pittsburgh Medical Center, and University of Pittsburgh Cancer Institute, Pittsburgh, Pennsylvania 15213-2582, USA. rschoen@pitt.edu

• PMID: 19818779
• PMCID: PMC2813330
• DOI: 10.1053/j.gastro.2009.09.062

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Robert E Schoen et al. Gastroenterology. 2010 Jan.

• ¹ Department of Medicine, University of Pittsburgh Medical Center, and University of Pittsburgh Cancer Institute, Pittsburgh, Pennsylvania 15213-2582, USA. rschoen@pitt.edu

• PMID: 19818779
• PMCID: PMC2813330
• DOI: 10.1053/j.gastro.2009.09.062

Item in Clipboard

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.

Copyright 2010 AGA Institute. Published by Elsevier Inc. All rights reserved.

PubMed Disclaimer

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.

Kaplan-Meier probability curve for surveillance…

Kaplan-Meier probability curve for surveillance colonoscopy use by year from baseline diagnostic colonoscopy…

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).

CRC = Colorectal Cancer, AA= advanced…

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.

CRC = Colorectal Cancer, AA= advanced…

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.

• Community colonoscopy: a gordian knot?

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