Adherence to surveillance guidelines after removal of colorectal adenomas: a large, community-based study
| Autor: | S. Lucas Goede, Pieter Spoelstra, Frank ter Borg, Marjolein van Ballegooijen, Else-Mariëtte B. van Heijningen, W. Lesterhuis, Ewout W. Steyerberg, Leopold G.J.B. Engels, Jan J. Koornstra, Evelien Dekker, Clemens J.M. Bolwerk, Iris Lansdorp-Vogelaar, Harry J. de Koning, Robin Timmer, Jan H. Kleibeuker, Juda Vecht, Ernst J. Kuipers |
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| Přispěvatelé: | Guided Treatment in Optimal Selected Cancer Patients (GUTS), AGEM - Amsterdam Gastroenterology Endocrinology Metabolism, CCA -Cancer Center Amsterdam, Gastroenterology and Hepatology, Public Health, Molecular Genetics, Gastroenterology & Hepatology, Neurosciences |
| Předmět: |
Male
COLONOSCOPY Pediatrics Time Factors Colorectal cancer medicine.medical_treatment Colonoscopy Risk Factors COLORECTAL ADENOMAS Medicine Colectomy Netherlands RISK medicine.diagnostic_test Medical record Gastroenterology Middle Aged CANCER Population Surveillance Female Guideline Adherence NATIONWIDE SURVEY Colorectal Neoplasms Adenoma Adult medicine.medical_specialty Colon APPROPRIATENESS UNITED-STATES Diagnosis Differential SDG 3 - Good Health and Well-being ENDOSCOPIC POLYPECTOMY SURVEILLANCE Humans POLYP SURVEILLANCE POST-POLYPECTOMY SURVEILLANCE Aged Retrospective Studies business.industry Cancer Retrospective cohort study Guideline medicine.disease Surgery CLINICAL-PRACTICE Neoplasm Recurrence Local FOLLOW-UP business |
| Zdroj: | EUR Research Portal Gut, 64(10), 1584-1592. BMJ PUBLISHING GROUP Gut Gut, 64(10), 1584-1592. BMJ Publishing Group Gut, 64(10), 1584-U111. BMJ Publishing Group |
| ISSN: | 0017-5749 |
| Popis: | Objective To determine adherence to recommended surveillance intervals in clinical practice.Design 2997 successive patients with a first adenoma diagnosis (57% male, mean age 59 years) from 10 hospitals, who underwent colonoscopy between 1998 and 2002, were identified via Pathologisch Anatomisch Landelijk Geautomatiseerd Archief: Dutch Pathology Registry. Their medical records were reviewed until 1 December 2008. Time to and findings at first surveillance colonoscopy were assessed. A surveillance colonoscopy occurring within +/- 3 months of a 1-year recommended interval and +/- 6 months of a recommended interval of 2 years or longer was considered appropriate. The analysis was stratified by period per change in guideline (before 2002: 2-3 years for patients with 1 adenoma, annually otherwise; in 2002: 6 years for 1-2 adenomas, 3 years otherwise). We also assessed differences in adenoma and colorectal cancer recurrence rates by surveillance timing.Results Surveillance was inappropriate in 76% and 89% of patients diagnosed before 2002 and in 2002, respectively. Patients eligible under the pre-2002 guideline mainly received surveillance too late or were absent (57% of cases). For patients eligible under the 2002 guideline surveillance occurred mainly too early (48%). The rate of advanced neoplasia at surveillance was higher in patients with delayed surveillance compared with those with too early or appropriate timed surveillance (8% vs 4-5%, pConclusions There is much room for improving surveillance practice. Less than 25% of patients with adenoma receive appropriate surveillance. Such practice seriously hampers the effectiveness and efficiency of surveillance, as too early surveillance poses a considerable burden on available resources while delayed surveillance is associated with an increased rate of advanced adenoma and especially colorectal cancer. |
| Databáze: | OpenAIRE |
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