Adherence to post-polypectomy surveillance guidelines: a systematic review and meta-analysis

Area of Science:

• Gastroenterology
• Oncology
• Public Health

Background:

• Colorectal cancer (CRC) remains a leading cause of cancer mortality worldwide.
• Surveillance colonoscopy programs aim to reduce CRC morbidity and mortality through guideline-recommended intervals.
• Clinical practice adherence to these intervals is crucial for program effectiveness.

Purpose of the Study:

• To evaluate adherence to guideline-recommended surveillance colonoscopy intervals.
• To determine the extent of early repeat colonoscopies.
• To identify reasons for nonadherence to surveillance guidelines.

Main Methods:

• A literature search was conducted for studies on surveillance colonoscopy guideline adherence.
• Exclusion criteria included inflammatory bowel disease and hereditary CRC syndromes.
• Primary outcome was correct interval assignment; adherence was assessed against North American and European guidelines.

Main Results:

• Sixteen studies were analyzed, revealing a mean adherence rate of 48.8%.
• Adherence varied by guideline and lesion risk: North American (44.7% low-risk, 54.6% high-risk), European (24.4% low-risk, 73.6% high-risk).
• Early repeat colonoscopies were most frequent after detection of hyperplastic polyps or low-risk adenomas.

Conclusions:

• Global adherence to surveillance colonoscopy guidelines is suboptimal.
• More than 50% of patients undergo repeat colonoscopies outside recommended intervals.
• Nonadherence, particularly early repeat procedures for low-risk findings, warrants further investigation.