Timing of Repeat Colonoscopy: Disparity Between Guidelines and Endoscopists’ Recommendation
Background
Colonoscopy possesses the highest sensitivity of available screening tests for colorectal cancer and polyps, but it also carries risks. Appropriate intervals for repeating colonoscopy are important to ensure that the benefits of screening and surveillance are not offset by harms. The study objective was to examine whether endoscopists’ recommendations for repeat colonoscopy, as communicated to primary care clinicians after the procedure, adhered to published guidelines.
Methods
Analysts abstracted medical records at ten primary care practices in Virginia and Maryland in 2006. The records of a random sample of men and women (300 per practice) aged 50 to 70 years were reviewed. The sample included patients who had a colonoscopy and a written report from an endoscopist, and who lacked designated risk factors. The main outcome was concordance between endoscopists’ recommendations and published guidelines regarding repeat colonoscopy.
Results
Of 3000 charts reviewed, 1282 (42.7%) included records of a colonoscopy and 1021 (34%) included an endoscopist’s report. In 64.9% of communications, the endoscopist specified when retesting should occur. Recommendations were consistent with contemporaneous guidelines in only 39.2% of cases and with current guidelines in 36.7% of cases. The adjusted mean number of years in which repeat colonoscopy was recommended was 7.8 years following normal colonoscopy and 5.8 years and 4.4 years, respectively, when hyperplastic polyps or 1–2 small adenomatous polyps were found.
Conclusions
Endoscopists often recommended repeat colonoscopy at shorter intervals than are advised either by current guidelines or by guidelines in effect at the time of the procedure. Endoscopists’ communications to primary care clinicians often lacked contextual information that might explain these discrepancies. Unless appropriate caveats apply, adhering to endoscopists’ recommendations may incur unnecessary harms and costs.
aDepartment of Family Medicine, Virginia Commonwealth University, Richmond, Virginia
bDepartment of Epidemiology and Community Health, Virginia Commonwealth University, Richmond, Virginia
cFairfax Family Practice Residency, Fairfax, Virginia
dShenandoah Valley Family Practice Residency Program, Front Royal, Virginia
eChesterfield Family Medicine Residency, Richmond, Virginia
fSt. Francis Family Medicine Residency, Richmond, Virginia
hDepartment of Family Medicine, Georgetown University, Washington DC
Address correspondence and reprint requests to: Alex H. Krist, MD, MPH, 3825 Charles Stewart Drive, Fairfax VA 22033.
The full text of this article is available via AJPM Online at www.ajpm-online.net; 1 unit of Category-1 CME credit is also available, with details on the website.
ABSTRACT