van der Meulen Miriam P, Korfage Ida J, van Heijningen Else-Mariëtte B, de Koning Harry J, van Leerdam Monique E, Dekker Evelien, Lansdorp-Vogelaar Iris
Department of Public Health, Erasmus Medical Centre, Rotterdam, The Netherlands.
Department of Gastroenterology, The Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands.
Endosc Int Open. 2020 Oct;8(10):E1405-E1413. doi: 10.1055/a-1190-3656. Epub 2020 Sep 22.
Low adherence to the Dutch guideline for colonoscopy surveillance after polypectomy led to release of a new guideline in 2013. This new guideline was risk-stratified at a more detailed level than the previous one to achieve more efficient use of colonoscopy resources. This study assessed the feasibility of the risk-stratified guideline by evaluating correct interpretation of and adherence to this guideline. Based on semi-structured interviews with 10 gastroenterologists, we developed an online survey to evaluate gastroenterologists' recommendations for surveillance in 15 example cases of patients with polyps. If recommended intervals differed from the new guideline, respondents were asked to indicate their motives for doing so. Ninety-one of 592 (15.4 %) invited gastroenterologists responded to at least one case, of whom 84 (14.2 %) completed the survey. Gastroenterologists gave a correct recommendation in a median of 10 of 15 cases and adherence per case ranged from 14 % to 95 % (median case 76 %). The two cases that addressed management of serrated polyps were least often answered correctly (14 % and 28 % correct answers). Discrepancies were mainly due to misinterpretation of the guideline with respect to serrated polyps (48 %) or misreading of the questions (30 %). Median adherence to the updated colonoscopy surveillance guideline of 76 % seems reasonable, and is higher than adherence to the previous guideline (range: 22 %-80 %, median 59 %). This shows that detailed (more complex) risk stratification for designation of a surveillance interval is feasible. Adherence could potentially be improved by clarifying correct interpretation of serrated polyps.
息肉切除术后对荷兰结肠镜监测指南的低依从性导致了2013年发布了新指南。该新指南比之前的指南在更详细的层面进行了风险分层，以更有效地利用结肠镜资源。本研究通过评估对该指南的正确解读和依从性来评估风险分层指南的可行性。基于对10位胃肠病学家的半结构化访谈，我们开展了一项在线调查，以评估胃肠病学家对15例息肉患者监测的建议。如果推荐的间隔与新指南不同，要求受访者说明这样做的动机。592名受邀胃肠病学家中有91名（15.4%）至少对1例做出了回应，其中84名（14.2%）完成了调查。胃肠病学家在15例病例中的中位数为10例给出了正确建议，每例的依从性范围为14%至95%（中位数病例为76%）。涉及锯齿状息肉管理的两个病例回答正确的频率最低（正确答案分别为14%和28%）。差异主要是由于对锯齿状息肉指南解读错误（48%）或对问题误读（30%）。对更新后的结肠镜监测指南76%的中位数依从性似乎是合理的，并且高于对先前指南的依从性（范围：22% - 80%，中位数59%）。这表明指定监测间隔的详细（更复杂）风险分层是可行的。通过澄清对锯齿状息肉的正确解读，依从性可能会得到提高。
