title: Adherence to surveillance guidelines after removal of colorectal adenomas: a large, community-based study.
abstract: OBJECTIVE
  To determine adherence to recommended surveillance intervals in clinical practice.
  
  
  METHODS
  2997 successive patients with a first adenoma diagnosis (57% male, mean age 59 years) from 10 hospitals, who underwent colonoscopy between 1998 and 2002, were identified via Pathologisch Anatomisch Landelijk Geautomatiseerd Archief: Dutch Pathology Registry. Their medical records were reviewed until 1 December 2008. Time to and findings at first surveillance colonoscopy were assessed. A surveillance colonoscopy occurring within ± 3 months of a 1-year recommended interval and ± 6 months of a recommended interval of 2 years or longer was considered appropriate. The analysis was stratified by period per change in guideline (before 2002: 2-3 years for patients with 1 adenoma, annually otherwise; in 2002: 6 years for 1-2 adenomas, 3 years otherwise). We also assessed differences in adenoma and colorectal cancer recurrence rates by surveillance timing.
  
  
  RESULTS
  Surveillance was inappropriate in 76% and 89% of patients diagnosed before 2002 and in 2002, respectively. Patients eligible under the pre-2002 guideline mainly received surveillance too late or were absent (57% of cases). For patients eligible under the 2002 guideline surveillance occurred mainly too early (48%). The rate of advanced neoplasia at surveillance was higher in patients with delayed surveillance compared with those with too early or appropriate timed surveillance (8% vs 4-5%, p<0.01).
  
  
  CONCLUSIONS
  There is much room for improving surveillance practice. Less than 25% of patients with adenoma receive appropriate surveillance. Such practice seriously hampers the effectiveness and efficiency of surveillance, as too early surveillance poses a considerable burden on available resources while delayed surveillance is associated with an increased rate of advanced adenoma and especially colorectal cancer.
authors.affiliation: Department of Public Health, Erasmus MC University Medical Centre, Rotterdam, the Netherlands.
authors.forename: Else-Mariëtte B
authors.initials: EM
authors.lastname: van Heijningen
authors.affiliation: Department of Public Health, Erasmus MC University Medical Centre, Rotterdam, the Netherlands.
authors.forename: Iris
authors.initials: I
authors.lastname: Lansdorp-Vogelaar
authors.affiliation: Department of Public Health, Erasmus MC University Medical Centre, Rotterdam, the Netherlands.
authors.forename: Ewout W
authors.initials: EW
authors.lastname: Steyerberg
authors.affiliation: Department of Public Health, Erasmus MC University Medical Centre, Rotterdam, the Netherlands.
authors.forename: S Lucas
authors.initials: SL
authors.lastname: Goede
authors.affiliation: Department of Gastroenterology and Hepatology, Academic Medical Centre, University of Amsterdam, Amsterdam, the Netherlands.
authors.forename: Evelien
authors.initials: E
authors.lastname: Dekker
authors.affiliation: Department of Gastroenterology and Hepatology, Erasmus MC University Medical Centre, Rotterdam, the Netherlands Department of Gastroenterology, Albert Schweitzer hospital, Dordrecht, the Netherlands.
authors.forename: Wilco
authors.initials: W
authors.lastname: Lesterhuis
authors.affiliation: Department of Gastroenterology and Hepatology, Deventer Hospital, Deventer, the Netherlands.
authors.forename: Frank
authors.initials: F
authors.lastname: ter Borg
authors.affiliation: Department of Gastroenterology and Hepatology, Isala Clinics, Zwolle, the Netherlands.
authors.forename: Juda
authors.initials: J
authors.lastname: Vecht
authors.affiliation: Department of Gastroenterology and Hepatology, Medical Centre Leeuwarden, Leeuwarden, the Netherlands.
authors.forename: Pieter
authors.initials: P
authors.lastname: Spoelstra
authors.affiliation: Department of Gastroenterology and Hepatology, Orbis Medical Centre, Sittard, the Netherlands.
authors.forename: Leopold
authors.initials: L
authors.lastname: Engels
authors.affiliation: Department of Gastroenterology and Hepatology, Reinier de Graaf Hospital, Delft, the Netherlands.
authors.forename: Clemens J M
authors.initials: CJ
authors.lastname: Bolwerk
authors.affiliation: Department of Gastroenterology and Hepatology, St. Antonius Hospital, Nieuwegein, the Netherlands.
authors.forename: Robin
authors.initials: R
authors.lastname: Timmer
authors.affiliation: Department of Gastroenterology, University Medical Centre Groningen, University of Groningen, Groningen, the Netherlands.
authors.forename: Jan H
authors.initials: JH
authors.lastname: Kleibeuker
authors.affiliation: Department of Gastroenterology, University Medical Centre Groningen, University of Groningen, Groningen, the Netherlands.
authors.forename: Jan J
authors.initials: JJ
authors.lastname: Koornstra
authors.affiliation: Department of Public Health, Erasmus MC University Medical Centre, Rotterdam, the Netherlands.
authors.forename: Harry J
authors.initials: HJ
authors.lastname: de Koning
authors.affiliation: Department of Gastroenterology and Hepatology, Erasmus MC University Medical Centre, Rotterdam, the Netherlands Department of Internal Medicine, Erasmus MC University Medical Centre, Rotterdam, the Netherlands.
authors.forename: Ernst J
authors.initials: EJ
authors.lastname: Kuipers
authors.affiliation: Department of Public Health, Erasmus MC University Medical Centre, Rotterdam, the Netherlands.
authors.forename: Marjolein
authors.initials: M
authors.lastname: van Ballegooijen
mesh_terms: D000236:Adenoma / Q000175:diagnosis* / Q000453:epidemiology / Q000601:surgery; D000328:Adult; D000368:Aged; D003082:Colectomy; D003113:Colonoscopy / Q000379:methods*; D015179:Colorectal Neoplasms / Q000175:diagnosis* / Q000453:epidemiology / Q000601:surgery; D003937:Diagnosis, Differential; D005260:Female; D019983:Guideline Adherence; D006801:Humans; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology; D009426:Netherlands / Q000453:epidemiology; D011159:Population Surveillance; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors
keywords: COLONOSCOPY; COLORECTAL ADENOMAS; ENDOSCOPIC POLYPECTOMY; SURVEILLANCE