Applying evidence-based guidelines improves use of colonoscopy resources in patients with a moderate risk of colorectal neoplasia.
OBJECTIVE
To determine whether applying National Health and Medical Research Council (NHMRC) guidelines for colorectal cancer prevention would reduce the number of follow-up colonoscopies.


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


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


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


METHODS
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.


METHODS
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.
Bampton
Peter A
PA
Department of Gastroenterology and Hepatology, Flinders Medical Centre, Bedford Park, SA. peter.bampton@flinders.edu.au
Sandford
Jayne J
JJ
Young
Graeme P
GP
D000236:Adenoma / Q000601:surgery; D001315:Australia; D003111:Colonic Polyps / Q000601:surgery; D003113:Colonoscopy / Q000706:statistics & numerical data; D015179:Colorectal Neoplasms / Q000235:genetics / Q000517:prevention & control*; D019317:Evidence-Based Medicine; D005260:Female; D019983:Guideline Adherence; D006801:Humans; D008297:Male; D008485:Medical Audit; D008875:Middle Aged; D017410:Practice Guidelines as Topic / Q000592:standards*; D011446:Prospective Studies; D012307:Risk Factors; D013997:Time Factors