Rosas Ulysses S, Pan Jennifer Y, Sundaram Vandana, Su Andrew, Fazal Muhammad, Dinh Philip, Ladabaum Uri
Department of Medicine, Karsh Division of Gastroenterology and Hepatology, Cedars-Sinai Medical Center, Los Angeles, California.
Department of Medicine, Division of Gastroenterology and Hepatology, Stanford University School of Medicine, Stanford, California.
Gastro Hep Adv. 2022 Jul 31;2(1):132-143. doi: 10.1016/j.gastha.2022.07.014. eCollection 2023.
The 2012 and 2020 US Multi-Society Task Force postpolypectomy guidelines have recommended progressively longer surveillance intervals for patients with low-risk adenomas (LRAs). These guidelines require data from past colonoscopies. We examined the impact of the 2012 guidelines for second surveillance on clinical practice, including the availability of prior colonoscopy data, with the aim of informing the implementation of the 2020 guidelines.
We identified surveillance colonoscopies at Stanford Health Care and the Palo Alto Veterans Affairs Health Care System in 3 periods: preguideline (March-August 2012), postguideline (January-June 2013), and delayed postguideline (July-September 2017). We collected data on the most recent previous colonoscopy, findings at the study entry surveillance colonoscopy, and recommendations for subsequent surveillance.
Among 977 patients, the most recent prior colonoscopy data were available in 78% of preguideline, 78% of postguideline, and 61% of delayed postguideline cases ( < .001). The fraction of surveillance colonoscopy reports that deferred recommendations awaiting pathology increased from 6% to 11% in preguideline and postguideline to 59% in delayed postguideline cases ( < .001). Overall adherence to guidelines for subsequent surveillance was similar in all 3 periods (54%-67%; = .089). In the postguideline and delayed postguideline periods combined, a 10-year subsequent surveillance interval was recommended in 0 of 29 cases with LRA followed by normal surveillance colonoscopy.
In patients undergoing surveillance, prior colonoscopy data were not always available and recommendations were often deferred awaiting pathology. Adherence to subsequent surveillance guidelines was suboptimal, especially for LRA followed by normal colonoscopy. Strategies addressing these gaps are needed to optimize implementation of the updated 2020 postpolypectomy guidelines.
2012年和2020年美国多学会息肉切除术后工作组指南建议，对于低风险腺瘤（LRA）患者，监测间隔应逐渐延长。这些指南需要既往结肠镜检查的数据。我们研究了2012年指南对二次监测临床实践的影响，包括既往结肠镜检查数据的可得性，旨在为2020年指南的实施提供参考。
我们确定了斯坦福医疗保健中心和帕洛阿尔托退伍军人事务医疗保健系统在3个时间段的监测结肠镜检查：指南发布前（2012年3月至8月）、指南发布后（2013年1月至6月）和指南发布后延迟期（2017年7月至9月）。我们收集了关于最近一次既往结肠镜检查、研究入组监测结肠镜检查的结果以及后续监测建议的数据。
在977例患者中，78%的指南发布前病例、78%的指南发布后病例和61%的指南发布后延迟期病例可获得最近一次既往结肠镜检查数据（P<0.001）。监测结肠镜检查报告中等待病理结果而推迟建议的比例从指南发布前的6%增加到指南发布后的11%，在指南发布后延迟期病例中增加到59%（P<0.001）。在所有3个时间段，后续监测对指南的总体依从性相似（54%-67%；P=0.089）。在指南发布后和指南发布后延迟期合并的情况下，29例LRA患者在随后的监测结肠镜检查正常后，无一例被建议进行10年的后续监测。
在接受监测的患者中，既往结肠镜检查数据并非总是可得，建议通常会因等待病理结果而推迟。对后续监测指南的依从性欠佳，尤其是对于LRA患者随后结肠镜检查正常的情况。需要采取策略来弥补这些差距，以优化2020年更新的息肉切除术后指南的实施。
