Comparing the resource implications of old and new colorectal adenoma surveillance guidelines in Australia

Abstract

BackgroundThe latest update to the Australian adenoma surveillance guideline in 2018 introduced a novel risk stratification system with updated surveillance recommendations. The resource implications of adopting this new system are unclear.AimsTo quanitfy the resource demands of adopting new over old adenoma surveillance guidelines.MethodsWe studied data from 2443 patients undergoing colonoscopies, in which a clinically significant lesion was identified in their latest, or previous procedure(s) across five Australian hospitals. We excluded procedures with inflammatory bowel disease, new or prior history of colorectal cancer or resection, inadequate bowel preparation and incomplete procedures. Old and new Australian surveillance intervals were calculated according to the number, size and histological characteristics of lesions identified. We used these data to compare the rate of procedures according to each guideline.ResultsBased on the procedures for 766 patients, the new surveillance guidelines significantly increased the number of procedures allocated an interval of 1 year (relative risk (RR): 1.57, P = 0.009) and 10 years (RR: 3.83, P < 0.00001) and reduced those allocated to half a year (RR: 0.08, P = 0.00219), 3 years (RR: 0.51, P < 0.00001) and 5 years (RR: 0.59, P < 0.00001). Overall, this reduced the relative number of surveillance procedures by 21% over 10 years (25.92 vs 32.78 procedures/100 patient‐years), which increased to 22% after excluding patients 75 or older at the time of surveillance (19.9 vs 25.65 procedures/100 patient‐years).ConclusionThe adoption of the latest Australian adenoma surveillance guidelines can reduce demand for surveillance colonoscopy by more than a fifth (21–22%) over 10 years.

Improving Concordance Between Clinicians With Australian Guidelines for Bowel Cancer Prevention Using a Digital Application: Randomized Controlled Crossover Study

“…Tsai-Wing Ow 1 MBBS, FRACP; Olga Sukocheva 1 BSc, PhD; Peter Bampton 1 MBBS, FRACP; Guru Iyngkaran 2 MBBS, FRACP, PhD; Chris Rayner 3 MBBS, FRACP, PhD; Edmund Tse 1 MBBS, FRACP, PhD 1 Royal Adelaide Hospital Adelaide AU 2 Royal Melbourne Hospital Melbourne AU 3 University of Adelaide Adelaide AU Preprint Settings 1) Would you like to publish your submitted manuscript as preprint?…”

“…As a result, the guidelines now describe up to 230 different screening or surveillance scenarios, requiring clinicians to navigate through multiple tables to determine an appropriate recommendation. While implementing these changes can considerably improve resource utilisation, this complexity may be a barrier to adherence, limiting the benefits of the guidelines [3][4]. Consequently, there is a need for tools to support clinicians using these guidelines.…”

“…These three tools provide greater ease of use by not requiring users to work through the risk tables manually. To the best of our knowledge, only the CRCwebapp has been validated against all 230 possible case scenarios due to its use as a research tool in a previously published study [3]. However, none of these has been evaluated for its ability to improve the rate of guideline concordance amongst clinicians.…”