title: Factors associated with adherence to the recommended postpolypectomy surveillance interval.
abstract: BACKGROUND
  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.
  
  
  METHODS
  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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Samsung Medical Center, Department of Medicine, Sungkyunkwan University School of Medicine, 50 Irwon-dong, Gangnam-gu, Seoul 135-710, Korea.
authors.forename: Eun Ran
authors.initials: ER
authors.lastname: Kim
authors.forename: Dong Hyun
authors.initials: DH
authors.lastname: Sinn
authors.forename: Jin Yong
authors.initials: JY
authors.lastname: Kim
authors.forename: Dong Kyung
authors.initials: DK
authors.lastname: Chang
authors.forename: Poong-Lyul
authors.initials: PL
authors.lastname: Rhee
authors.forename: Jae J
authors.initials: JJ
authors.lastname: Kim
authors.forename: Jong Chul
authors.initials: JC
authors.lastname: Rhee
authors.forename: Young-Ho
authors.initials: YH
authors.lastname: Kim
mesh_terms: D011125:Adenomatous Polyposis Coli / Q000175:diagnosis* / Q000601:surgery; D000328:Adult; D000368:Aged; D001291:Attitude of Health Personnel; D002983:Clinical Competence / Q000592:standards; D015179:Colorectal Neoplasms / Q000517:prevention & control*; D003107:Colorectal Surgery / Q000592:standards; D057210:Delayed Diagnosis; D003951:Diagnostic Errors; D055088:Early Detection of Cancer / Q000379:methods / Q000592:standards; D005260:Female; D019983:Guideline Adherence; D006801:Humans; D008297:Male; D008875:Middle Aged; D017410:Practice Guidelines as Topic; D011230:Precancerous Conditions / Q000175:diagnosis / Q000601:surgery; D011446:Prospective Studies; D055815:Young Adult