Endoscopist Adherence to Post-polypectomy Surveillance Interval Recommendations Following Removal of 1-4 Non-advanced...

Current post-polypectomy surveillance guidelines (updated in 2020) recommend a 7-10-year surveillance interval for patients with 1-2 non-advanced adenomas (NAAs) and a 3-5-year interval for those with 3-4 NAAs; however, endoscopist adherence to guideline recommendations is unknown. Therefore, we evaluated endoscopist adherence to guideline recommendations and use of interval ranges in a large integrated healthcare system.

The cross-sectional study was conducted with average-risk adult Kaiser Permanente Northern California patients who underwent a colonoscopy with removal of 1-4 NAAs in 2019-2024. Surveillance intervals were obtained from colonoscopy procedure flowsheets. The proportion of colonoscopies with a guideline adherent surveillance interval and use of interval ranges were calculated annually.

Endoscopist adherence to the 7-10-year interval for patients with 1-2 NAAs improved from 68.1% in 2021 to 71.9% in 2024. In contrast, adherence to the 3-5-year interval for patients with 3-4 NAAs was consistently greater than 90.0%. For both 1-2 and 3-4 NAAs groups, endoscopists predominantly assigned the upper or lower bound of the interval range rather the middle years. In 2021-2024, a 10-year interval was assigned in 45.9% to 47.2% of patients with 1-2 NAAs. A 5-year interval was assigned in 37.6% to 39.5% of patients with 3-4 NAAs.

Since the update to post-polypectomy surveillance guidelines in 2020, endoscopist adherence to recommended follow-up intervals for patients with 1-2 NAAs has improved. However, adherence to recommended follow-up intervals remains lower for patients with 1-2 NAA compared to those with 3-4 NAAs. These disparate adherence rates suggest that the potential for over-surveillance is substantially higher for patients with 1-2 versus 3-4 NAAs.