title: An evaluation of colonoscopy surveillance guidelines: are we actually adhering to the guidelines?
abstract: BACKGROUND
  National guidelines put forth by the American Cancer Society, the US Multi-Society Task Force on Colorectal Cancer, and the American College of Gastroenterology provide recommendations regarding colorectal cancer screening and follow-up surveillance. Practice patterns may differ from these guidelines. This study analyzes the concordance between a tertiary equal access system and national guidelines for colorectal cancer and polyp surveillance.
  
  
  METHODS
  We performed a retrospective database review of all patients at a single institution undergoing screening colonoscopy from 2010 to 2011. Patient demographics, indication for colonoscopy, pathologic findings, and follow-up recommendations documented by the provider were analyzed. Multivariate analysis was performed in an attempt to identify predictors of discordant recommendations.
  
  
  RESULTS
  One thousand four hundred twenty patients were identified (mean age, 54.3 ± 7.7 years, 48.6% women). The gastroenterology service performed the majority of colonoscopies (87.2%) compared with the surgery service (11.6%). The major indications were routine screening (84.4%) and a strong family history of colorectal cancer (12.2%). The adenoma detection rate for the entire cohort was 27.4%. Other pathologic conditions identified included hyperplastic polyps (16%), lymphoid aggregates (3.5%), and invasive adenocarcinoma (0.1%). Overall, follow-up recommendations correlated with established guidelines in 97% of cases. By multivariate analysis, only the final pathologic finding of lymphoid aggregates was associated with discordant recommendations (odds ratio [OR], 4.62; 95% confidence interval [CI], 1.64 to 12.99; P = .004). When comparing discordant recommendations between specialties, there was a statistically significant difference between gastroenterology (1.6%) and surgery (7.6%) (P < .0001) providers; surgeons trended toward recommending earlier follow-up examinations (P = .37).
  
  
  CONCLUSIONS
  Overall, surveillance recommendations correlated well with current national guidelines. Concordance rates were higher with gastroenterologists in this cohort. Alterations based on final pathologic examination and individual cases remain clinically important.
authors.affiliation: Department of Surgery, Madigan Army Medical Center, 9040 Fitzsimmons Dr, Fort Lewis, WA, USA.
authors.forename: Avery S
authors.initials: AS
authors.lastname: Walker
authors.forename: Daniel W
authors.initials: DW
authors.lastname: Nelson
authors.forename: John J
authors.initials: JJ
authors.lastname: Fowler
authors.forename: Marlin W
authors.initials: MW
authors.lastname: Causey
authors.forename: Samantha
authors.initials: S
authors.lastname: Quade
authors.forename: Eric K
authors.initials: EK
authors.lastname: Johnson
authors.forename: Justin A
authors.initials: JA
authors.lastname: Maykel
authors.forename: Scott R
authors.initials: SR
authors.lastname: Steele
mesh_terms: D000230:Adenocarcinoma / Q000175:diagnosis / Q000517:prevention & control; D000236:Adenoma / Q000175:diagnosis / Q000517:prevention & control; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003113:Colonoscopy / Q000592:standards* / Q000706:statistics & numerical data; D015179:Colorectal Neoplasms / Q000175:diagnosis* / Q000517:prevention & control; D003107:Colorectal Surgery / Q000592:standards / Q000706:statistics & numerical data; D055088:Early Detection of Cancer / Q000592:standards* / Q000706:statistics & numerical data; D005260:Female; D005500:Follow-Up Studies; D005762:Gastroenterology / Q000592:standards / Q000706:statistics & numerical data; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D006801:Humans; D007417:Intestinal Polyps / Q000175:diagnosis / Q000517:prevention & control; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D014861:Washington