Adherence to surveillance guidelines for colorectal adenomatous polyps in the elderly

Determining adherence to recommended surveillance intervals after polypectomy in elderly patients.

A retrospective cohort study including 531 patients aged above 70 years undergoing polypectomy between 2009-2011 in a large Dutch teaching hospital, identified using the hospital's pathology registry. Outcomes of the index colonoscopy were reviewed. The interval until the next colonoscopy was assessed and compared both to the advised interval according to the Dutch guidelines and the gastroenterologist's recommendation. Reasons for deviating from the guideline were assessed.

The initial recommendation of the gastroenterologist for the surveillance interval was in accordance to the guideline in 59.1% of the patients. In 21.8% the gastroenterologist's advice was not documented. In 15.8% of the patients the gastroenterologist recommended to perform surveillance endoscopy earlier than the guideline, mainly based on polyp characteristics. The gastroenterologist advised endoscopy when the guideline advised no surveillance at all in 1.0%, later than the guideline recommendation in 1.2%, or did not recommend surveillance when the guideline advised to continue in 1.0%. Actual surveillance intervals were in accordance to the guideline in 54.4% and in accordance to the initial advice of the gastroenterologist in 58.4% of the patients.

Only in 41% of patients was the gastroenterologist's recommendation regarding surveillance after polypectomy either absent (21.8%) or not in accordance to the guideline (19.2%). Future research should focus on developing an evidence-based decision algorithm for elderly patients to support gastroenterologists and patients in the choices regarding cessation of surveillance at a certain level of frailty, comorbidity or remaining life-expectancy.