Puylaert C C E M, Koster-van Ree M L, Verhagen M A M T, van Tuyl S A C, Hamaker M E
Department of Internal Medicine, Diakonessenhuis, Utrecht, the Netherlands Department of Geriatric Medicine, Diakonessenhuis, Zeist, the Netherlands.
Neth J Med. 2018 Oct;76(8):358-364.
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.
确定老年患者息肉切除术后遵循推荐监测间隔的情况。
一项回顾性队列研究，纳入了2009年至2011年间在一家大型荷兰教学医院接受息肉切除术的531名70岁以上患者，通过医院病理登记册进行识别。回顾了首次结肠镜检查的结果。评估了直至下一次结肠镜检查的间隔时间，并与荷兰指南建议的间隔时间以及胃肠病学家的建议进行了比较。评估了偏离指南的原因。
胃肠病学家对监测间隔的初始建议在59.1%的患者中符合指南。在21.8%的患者中，未记录胃肠病学家的建议。在15.8%的患者中，胃肠病学家建议比指南更早进行监测内镜检查，主要基于息肉特征。在1.0%的患者中，胃肠病学家在指南建议根本不进行监测时建议进行内镜检查，在1.2%的患者中建议时间晚于指南建议，或者在指南建议继续监测时不建议进行监测。实际监测间隔在54.4%的患者中符合指南，在58.4%的患者中符合胃肠病学家的初始建议。
仅在41%的患者中，胃肠病学家关于息肉切除术后监测的建议要么缺失（21.8%），要么不符合指南（19.2%）。未来的研究应侧重于为老年患者开发基于证据的决策算法，以支持胃肠病学家和患者在因一定程度的虚弱、合并症或预期剩余寿命而停止监测的选择方面做出决策。
