Endoscopist Adherence to Postpolypectomy Surveillance Interval Recommendations Following Removal of 1 to 4...

Current postpolypectomy surveillance guidelines (updated in 2020) recommend a 7- to 10-year surveillance interval for patients with 1 to 2 nonadvanced adenomas (NAAs) and a 3- to 5-year interval for those with 3 to 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 health care system.

The cross-sectional study was conducted with average-risk adult Kaiser Permanente Northern California patients who underwent a colonoscopy with removal of 1 to 4 NAAs in 2019 to 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- to 10-year interval for patients with 1 to 2 NAAs improved from 68.1% in 2021 to 71.9% in 2024. In contrast, adherence to the 3- to 5-year interval for patients with 3 to 4 NAAs was consistently greater than 90.0%. For both 1 to 2 and 3 to 4 NAAs groups, endoscopists predominantly assigned the upper or lower bound of the interval range rather than the middle years. In 2021 to 2024, a 10-year interval was assigned in 45.9%-47.2% of patients with 1 to 2 NAAs. A 5-year interval was assigned in 37.6%-39.5% of patients with 3 to 4 NAAs.

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