title: Surveillance colonoscopies for colorectal polyps--too often, too many! An Audit at a Large District General Hospital.
abstract: BACKGROUND
  The British society of Gastroenterologists (BSG) have laid down guidelines for surveillance colonoscopies in patients with large bowel adenomatous polyps. However, numerous studies have shown the gross over-utilization of colonoscopic services in their management. We audited our practice of polyp management and looked at guideline compliance amongst patients on our colonoscopic surveillance list.
  
  
  METHODS
  All patients undergoing adenoma surveillance and those with newly detected adenomas over a 2-month period were included in the first loop of the audit. Data on the colonoscopic findings, histology and management were retrieved from paper and on-line records. The BSG guidelines were printed, laminated and displayed in the colorectal clinics. Following this, we re-audited (second loop) our practice. In the second part of the study, we randomly retrieved 533/1800 case notes from our colonoscopic waiting list. Amongst those on surveillance for polyps, compliance was ascertained as regards need for procedure and appropriateness of surveillance interval.
  
  
  RESULTS
  Fifty-four patients were included in the first loop and 59 during the second loop of the audit. Guidelines were followed in 16% (4/25, 95% CI: 0.054-0.33) of patients in the first loop and 46.5% (13/28, 95% CI: 0.293-0.642) in the second loop (P = 0.017). Of the patients on our colonoscopic waiting list for adenomatous polyps, 17.7% satisfied guidelines, 23.4% did not require any further surveillance and 58.9% were booked for a procedure earlier than recommended.
  
  
  CONCLUSIONS
  The mere framing of guidelines is insufficient to improve clinical practice. Strategies to improve implementation need to be explored. Audit of individual practice is recommended.
authors.affiliation: Department of Colorectal Surgery, Mayday University Hospital, Croydon, UK. bjosephje@gmail.com
authors.forename: B J
authors.initials: BJ
authors.lastname: John
authors.forename: S
authors.initials: S
authors.lastname: Irukulla
authors.forename: G
authors.initials: G
authors.lastname: Pilgrim
authors.forename: I
authors.initials: I
authors.lastname: Swift
authors.forename: A M
authors.initials: AM
authors.lastname: Abulafi
mesh_terms: D003111:Colonic Polyps / Q000473:pathology / Q000601:surgery*; D003113:Colonoscopy / Q000706:statistics & numerical data*; D019983:Guideline Adherence; D006767:Hospitals, District; D006769:Hospitals, General; D006801:Humans; D006965:Hyperplasia; D007417:Intestinal Polyps / Q000601:surgery*; D008485:Medical Audit; D011159:Population Surveillance; D017410:Practice Guidelines as Topic; D012002:Rectal Diseases / Q000601:surgery*; D006113:United Kingdom