Real-world compliance with the 2020 U.S. Multi-Society Task Force on Colorectal Cancer polypectomy surveillance guidelines: an observational study

Dong, Jeffrey; Wang, Linda F.; Ardolino, Eric; Feuerstein, Joseph D.

doi:10.1016/j.gie.2022.08.020

Cited by 13 publications

(10 citation statements)

References 29 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Other theories of low compliance has been suggested, such as lack of guideline awareness, but a recent study suggested that this may not explain the low compliance [19]. A study showed that when endoscopists were given LRA and HRA surveys with clinical vignettes, they were able to answer them correctly despite their low compliance in clinical practice [19]. Again, endoscopists may feel the low strength of evidence may not be justi able enough to follow it in practice.…”

Section: Discussionmentioning

confidence: 99%

Appropriateness of recommendations for surveillance colonoscopy after polypectomy – a comparison of adherence to the 2012 and 2020 USMSTF guidelines

Idouchi,

Gregoski,

Rockey

2024

Preprint

View full text Add to dashboard Cite

Background Screening colonoscopy detects precancerous polyps, which when resected, prevents colon cancer. Recommendations for surveillance colonoscopy after polypectomy are based on the U.S. Multi-Society Task Force guidelines (USMSTF). Aim to examine provider recommendations based on 2012 and 2020 USMSTF guidelines. Methods A prospective analysis was performed to examine provider recommendations for index screening and surveillance colonoscopy from March 2022 to January 2023. Procedures with unknown histology or unsatisfactory bowel preparation were excluded. We recorded polyp morphology, histology, and subsequent recommendations made by endoscopists, to compare to the USMSTF guidelines. Results 241 patients were included, with 371 endoscopies reviewed. For index screening colonoscopies, 86%, performed between 2012 and 2020, adhered to 2012 guidelines, while 71%, performed after 2020, adhered to the 2020 guidelines. For surveillance colonoscopies, 62% from 2012 and 2020, and 50% after 2020, adhered to the 2012 and 2020 guidelines, respectively (P < 0.001). For polyp types, recommendations after index colonoscopies showed low-risk adenoma (LRA) had 88% adherence to 2012 guidelines versus 73% adherence to 2020 guidelines. For surveillance colonoscopies, LRA had 73% adherence to 2012 guidelines versus 42% adherence to 2020 guidelines (P < 0.001). Recommendations after index colonoscopy showed high-risk adenoma (HRA) had 79% adherence to 2012 guidelines versus 63% adherence to 2020 guidelines. For surveillance colonoscopies, HRA had 88% adherence to the 2012 guidelines versus 69% adherence to 2020 guidelines (P < 0.001). Conclusions Adherence declined for the introduction of 2020 guidelines and was poorer after 2nd surveillance exams. Increasing the evidence for interval recommendations may increase guideline adherence.

show abstract

Section: Discussionmentioning

confidence: 99%

Appropriateness of recommendations for surveillance colonoscopy after polypectomy – a comparison of adherence to the 2012 and 2020 USMSTF guidelines

Idouchi,

Gregoski,

Rockey

2024

Preprint

View full text Add to dashboard Cite

show abstract

“…Arguably, mt-sDNA may be more apropos for interval testing in patients with CRC risk factors, especially considering poor compliance observed with the most recent guidelines advising liberally spaced screening and polyp surveillance intervals. 8,9 Alternatively, it could be used as a subsequent screening or surveillance method for patients with CRC risk factors and age or morbidity-related procedural hesitancy.…”

Section: Discussionmentioning

confidence: 99%

“…Factoring conclusions from the Mayo group along with our observations, it seems a positive mt-sDNA result in patients with a family history of CRC or those who have had prior screening colonoscopy (with or without adenomatous polyps found) predicts a high likelihood of detecting neoplasia. Arguably, mt-sDNA may be more apropos for interval testing in patients with CRC risk factors, especially considering poor compliance observed with the most recent guidelines advising liberally spaced screening and polyp surveillance intervals 8,9 . Alternatively, it could be used as a subsequent screening or surveillance method for patients with CRC risk factors and age or morbidity-related procedural hesitancy.…”

Section: Discussionmentioning

confidence: 99%

Influence of Colorectal Cancer Risk Factors on Predictive Value of a Positive Multitarget Stool DNA Test

Narayani¹,

Narayani²

2023

Journal of Clinical Gastroenterology

View full text Add to dashboard Cite

Goals: We analyzed if the predictive value of multitarget stool-based DNA (mt-sDNA) varied when patients had pre-existing known colorectal cancer (CRC) risk factors. Background: mt-sDNA test is approved for CRC screening in average-risk patients. Whether patients with a personal history of adenomatous colon polyps or a family history of CRC (CRC risk factors) benefit from mt-sDNA testing is unknown. Study: We reviewed charts for all positive mt-sDNA referrals between 2017 and 2021. Diagnostic colonoscopy adherence rates were calculated. In those who had colonoscopy, we compared detection rates for any colorectal neoplasia (CRN), multiple (3 or more) adenomas, sessile serrated polyps (SSP), advanced CRN, and CRC between patients with and without known CRC risk factors. Results: Of 1297 referrals for positive mt-sDNA, 1176 (91%) completed a diagnostic colonoscopy. The absence of neoplasia was noted in 27% of colonoscopy exams. When neoplasia was identified, findings were as follows: any CRN (73%), multiple adenomas (34%), SSP (23%), advanced CRN (33%), and CRC (2.5%). One or more CRC risk factors were present in 229 (19%) of cases. In the CRC risk factor subgroup, patients having a prior history of adenomatous polyps or a family history of CRC were no more likely to have any CRN, multiple adenomas, SSP, advanced CRN, or CRC compared to average-risk patients when mt-sDNA was positive. Conclusions: In this real-world analysis of positive mt-sDNA referrals, adherence to subsequent diagnostic colonoscopy recommendations was high. The presence of pre-existing CRC risk factors did not affect the positive predictive value of mt-sDNA.

show abstract

“…8 A study using clinical data found that the overall patient adherence was 48.9% to the 2020 US Multi-Society Task Force polypectomy surveillance guidelines. 9 A large-scale multicenter study 9 found that fewer than 25% of patients with adenoma had appropriate surveillance and that patients with delayed surveillance had a much higher rate of advanced neoplasia compared with patients with appropriate surveillance. Asid from patient factors, such as patient economic conditions and insurance-related issues, factors from the physician side are also associated with inappropriate postpolypectomy surveillance.…”

Section: Introductionmentioning

confidence: 99%

“…However, more than half of patients with a colorectal polyp resected do not receive surveillance colonoscopy within the recommended time . A study using clinical data found that the overall patient adherence was 48.9% to the 2020 US Multi-Society Task Force polypectomy surveillance guidelines . A large-scale multicenter study found that fewer than 25% of patients with adenoma had appropriate surveillance and that patients with delayed surveillance had a much higher rate of advanced neoplasia compared with patients with appropriate surveillance.…”

Section: Introductionmentioning

confidence: 99%

Development and Evaluation of a Surveillance System for Follow-Up After Colorectal Polypectomy

Wu,

Shi,

et al. 2023

JAMA Netw Open

View full text Add to dashboard Cite

ImportanceThe adherence of physicians and patients to published colorectal postpolypectomy surveillance guidelines varies greatly, and patient follow-up is critical but time consuming.ObjectivesTo evaluate the accuracy of an automatic surveillance (AS) system in identifying patients after polypectomy, assigning surveillance intervals for different risks of patients, and proactively following up with patients on time.Design, Setting, and ParticipantsIn this diagnostic/prognostic study, endoscopic and pathological reports of 47 544 patients undergoing colonoscopy at 3 hospitals between January 1, 2017, and June 30, 2022, were collected to develop an AS system based on natural language processing. The performance of the AS system was fully evaluated in internal and external tests according to 5 guidelines worldwide and compared with that of physicians. A multireader, multicase (MRMC) trial was conducted to evaluate use of the AS system and physician guideline adherence, and prospective data were collected to evaluate the success rate in contacting patients and the association with reduced human workload. Data analysis was conducted from July to September 2022.ExposuresAssistance of the AS system.Main Outcomes and MeasuresThe accuracy of the system in identifying patients after polypectomy, stratifying patient risk levels, and assigning surveillance intervals in internal (Renmin Hospital of Wuhan University), external 1 (Wenzhou Central Hospital), and external 2 (The First People’s Hospital of Yichang) test sets; the accuracy of physicians and their time burden with and without system assistance; and the rate of successfully informed patients of the system were evaluated.ResultsTest sets for 16 106 patients undergoing colonoscopy (mean [SD] age, 51.90 [13.40] years; 7690 females [47.75%]) were evaluated. In internal, external 1, and external 2 test sets, the system had an overall accuracy of 99.91% (95% CI, 99.83%-99.95%), 99.54% (95% CI, 99.30%-99.70%), and 99.77% (95% CI, 99.41%-99.91%), respectively, for identifying types of patients and achieved an overall accuracy of at least 99.30% (95% CI, 98.67%-99.63%) in the internal test set, 98.89% (95% CI, 98.33%-99.27%) in external test set 1, and 98.56% (95% CI, 95.86%-99.51%) in external test set 2 for stratifying patient risk levels and assigning surveillance intervals according to 5 guidelines. The system was associated with increased mean (SD) accuracy among physicians vs no AS system in 105 patients (98.67% [1.28%] vs 78.10% [18.01%]; P = .04) in the MRMC trial. In a prospective trial, the AS system successfully informed 82 of 88 patients (93.18%) and was associated with reduced burden of follow-up time vs no AS system (0 vs 2.86 h).Conclusions and RelevanceThis study found that an AS system was associated with improved adherence to guidelines among physicians and reduced workload among physicians and nurses.

show abstract

Real-world compliance with the 2020 U.S. Multi-Society Task Force on Colorectal Cancer polypectomy surveillance guidelines: an observational study

Cited by 13 publications

References 29 publications

Appropriateness of recommendations for surveillance colonoscopy after polypectomy – a comparison of adherence to the 2012 and 2020 USMSTF guidelines

Appropriateness of recommendations for surveillance colonoscopy after polypectomy – a comparison of adherence to the 2012 and 2020 USMSTF guidelines

Influence of Colorectal Cancer Risk Factors on Predictive Value of a Positive Multitarget Stool DNA Test

Development and Evaluation of a Surveillance System for Follow-Up After Colorectal Polypectomy

Contact Info

Product

Resources

About