Adherence to surveillance guidelines following colonic polypectomy is abysmal

Surveillance guidelines following excision of colonic tubular adenomas are well established. However, adherence to the guidelines are rarely audited. The aim of our study was to evaluate the rate of compliance to the recommended guidelines following polyp removal.

A review of a prospectively collected colonoscopy database in a single tertiary institution was conducted for all patients who underwent polypectomy in 2008. We excluded patients who were diagnosed with or had prior history of colorectal malignancy. The frequency of subsequent colonoscopic were evaluated against the recommended guidelines based on the clinico-histological characteristics of the removed polyps.

There were 419 colonoscopies with polypectomies performed in 2008. The patient cohort had a median age of 60 years (range, 26-95 years), with the most common diagnosis being tubular adenoma with low grade dysplasia (n=291, 69.5%). Adherence to Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) post-polypectomy surveillance guidelines, based on the factors such as the characteristics of the colonic polyps and bowel preparation at initial colonoscopy, was only 13.8% (n=58). There were 107 (25.5%) patients who had their surveillance endoscopy performed earlier than recommended. None of them were diagnosed with malignancy. The majority of patients (n=192, 45.8%), had surveillance scopes later than recommended or were lost to follow-up. Amongst these patients, two actually were diagnosed to have malignancy 3 and 5 years after their recommended surveillance scope date, respectively.

There is a very low compliance to post-polypectomy surveillance guidelines. More needs to be done to improve compliance to guidelines.