title: Adherence to recommended intervals for surveillance colonoscopy in average-risk patients with 1 to 2 small (<1 cm) polyps on screening colonoscopy.
abstract: BACKGROUND
  Among average-risk patients, repeat colonoscopy in 5 years is recommended after 1 to 2 small (<1 cm) adenomas are found on screening colonoscopy or in 10 years if hyperplastic polyps are found. However, sparse quantitative data are available about adherence to these recommendations or factors that may improve adherence.
  
  
  OBJECTIVE
  To quantify adherence to recommended intervals and to identify factors associated with lack of adherence.
  
  
  METHODS
  Retrospective endoscopic database analysis.
  
  
  METHODS
  Tertiary-care institution and Veterans Affairs Health System.
  
  
  METHODS
  Average-risk individuals undergoing screening colonoscopy found to have 1 to 2 small polyps on screening colonoscopy.
  
  
  METHODS
  Frequency of recommending repeat colonoscopy in 5 years if 1 to 2 small adenomas are found and in 10 years if hyperplastic polyps are found.
  
  
  RESULTS
  Of 922 outpatient screening colonoscopies with 1 to 2 small polyps found, 90.2% received appropriate recommendations for timing of repeat colonoscopy. Eighty-four percent of patients with 1 to 2 small adenomas and 94% of patients with 1 to 2 hyperplastic polyps received recommendations that were consistent with guidelines. Based on logistic regression analysis, patients aged >70 years (odds ratio [OR] 2.4, 95% confidence interval [CI], 1.0-5.7), fair bowel preparation (OR 12.7; 95% CI, 7.3-22.4), poor bowel preparation (OR 10.0; 95% CI, 4.3-23.6), and the presence of 2 small adenomas versus 1 small adenoma (OR 3.6; 95% CI, 2.2-6.0) were factors associated with "overuse" or recommendations inconsistent with guidelines.
  
  
  CONCLUSIONS
  Retrospective study design.
  
  
  CONCLUSIONS
  More than 90% of endoscopists' recommendations for timing of surveillance colonoscopy in average-risk patients with 1 to 2 small polyps are consistent with guideline recommendations. Quality of preparation is strongly associated with deviation from guideline recommendations.
authors.affiliation: Division of Gastroenterology, University of Michigan Health System, Ann Arbor, Michigan, USA; Division of Gastroenterology, Ann Arbor Veterans' Administration Health Care System, Ann Arbor, Michigan, USA.
authors.forename: Stacy B
authors.initials: SB
authors.lastname: Menees
authors.affiliation: Division of Gastroenterology, University of Michigan Health System, Ann Arbor, Michigan, USA; Division of Gastroenterology, Ann Arbor Veterans' Administration Health Care System, Ann Arbor, Michigan, USA.
authors.forename: Eric
authors.initials: E
authors.lastname: Elliott
authors.affiliation: Division of Gastroenterology, University of Michigan Health System, Ann Arbor, Michigan, USA.
authors.forename: Shail
authors.initials: S
authors.lastname: Govani
authors.affiliation: Division of Gastroenterology, Case Western Reserve University Hospital, Cleveland, Ohio, USA.
authors.forename: Constantinos
authors.initials: C
authors.lastname: Anastassiades
authors.affiliation: Division of Gastroenterology, University of Michigan Health System, Ann Arbor, Michigan, USA; Division of Gastroenterology, Ann Arbor Veterans' Administration Health Care System, Ann Arbor, Michigan, USA; Center for Clinical Management Research, Ann Arbor Veterans' Administration Health Care System, Ann Arbor, Michigan, USA.
authors.forename: Philip
authors.initials: P
authors.lastname: Schoenfeld
mesh_terms: D003111:Colonic Polyps / Q000473:pathology*; D003113:Colonoscopy / Q000592:standards*; D005260:Female; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D018570:Risk Assessment; D013997:Time Factors