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ARTICLE

Are Physicians Doing Too Much Colonoscopy? A National Survey of Colorectal Surveillance after Polypectomy

Pauline A. Mysliwiec, MD, MPH; Martin L. Brown, PhD; Carrie N. Klabunde, PhD; and David F. Ransohoff, MD

17 August 2004 | Volume 141 Issue 4 | Pages 264-271

Background: Increasing use of colonoscopy for colorectal cancer screening and surveillance of colorectal adenomas after polypectomy has given rise to concerns about the availability of endoscopic resources in the United States. Guidelines recommend surveillance after polypectomy at 3 to 5 years for a small adenoma, and follow-up is not advised for hyperplastic polyps. The intensity of physicians' surveillance is largely unstudied.

Objective: To survey practicing gastroenterologists and general surgeons about their perceived need for the frequency of surveillance after polypectomy, to compare survey responses to practice guidelines, and to identify factors influencing their recommendations for surveillance.

Design: Survey study conducted by the National Cancer Institute.

Setting: A nationally representative study of physicians in the United States.

Participants: 349 gastroenterologists and 316 general surgeons.

Measurements: Questionnaires mailed in 1999 and 2000 assessed physicians' recommendations for surveillance after polypectomy in asymptomatic, average-risk patients.

Results: Response rates were 83%. Among gastroenterologists (317 of 349) and surgeons (125 of 316) who perform screening colonoscopy, 24% (95% CI, 19.3% to 28.7%) of gastroenterologists and 54% (CI, 44.9% to 62.5%) of surgeons recommend surveillance for a hyperplastic polyp. For a small adenoma, most physicians recommended surveillance colonoscopy and more than 50% recommended examinations every 3 years or more often. Physicians indicated that published evidence was very influential in their practice (83% [CI, 78.8% to 87.2%] of gastroenterologists and 78% [CI, 72.5% to 86.8%] of surgeons). By contrast, only half of respondents reported that guidelines were very influential.

Limitations: The study was based on physicians' self-reported practice patterns. Results may overestimate or underestimate the performance of surveillance colonoscopy.

Conclusions: Some surveillance colonoscopy seems to be inappropriately performed and in excess of guidelines, particularly for hyperplastic polyps and low-risk lesions such as a small adenoma. These results suggest unnecessary demand for endoscopic resources.

Editors' Notes Context Colonoscopic surveillance following colon polypectomy is costly in terms of money and manpower. Clinical practice guidelines recommend different surveillance intervals after polypectomy, depending on the size, number, and histologic characteristics of the polyps identified; however, actual adherence to the guidelines is unknown. Contribution This nationally representative survey of gastroenterologists and general surgeons shows that physicians recommend surveillance colonoscopy much more frequently than clinical guidelines suggest, especially for hyperplastic polyps and small adenomas. Implications Unjustified overuse of surveillance colonoscopy after polypectomy seems to be widespread; this situation threatens to overwhelm the money and resources available for health care maintenance. –The Editors

 

Author and Article Information

From the National Cancer Institute, Bethesda, Maryland, and the University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.

Grant Support: By the National Cancer Institute (contract no. N01-PC-85169).

Potential Financial Conflicts of Interest: None disclosed.

Requests for Single Reprints: Martin Brown, PhD, National Cancer Institute, Executive Plaza North 4005, 6130 Executive Boulevard, Bethesda, MD 20892-7344; e-mail, mb53o{at}nih.gov.

Current Author Addresses: Dr. Mysliwiec: Department of Internal Medicine, Division of Gastroenterology, University of California, Davis, 4150 V Street, Suite 3508, Sacramento, CA 95817.

Drs. Brown and Klabunde: National Cancer Institute, Executive Plaza North 4005, 6130 Executive Boulevard, Bethesda, MD 20892-7344.

Dr. Ransohoff: CB # 7080, 4103 Bioinformatics Building, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599-7080.

Author Contributions: Conception and design: P.A. Mysliwiec, M.L. Brown, C.N. Klabunde, D.F. Ransohoff.

Analysis and interpretation of the data: P.A. Mysliwiec, M.L. Brown, C.N. Klabunde, D.F. Ransohoff.

Drafting of the article: P.A. Mysliwiec, M.L. Brown, C.N. Klabunde, D.F. Ransohoff.

Critical revision of the article for important intellectual content: P.A. Mysliwiec, M.L. Brown, C.N. Klabunde, D.F. Ransohoff.

Final approval of the article: P.A. Mysliwiec, M.L. Brown, C.N. Klabunde, D.F. Ransohoff.

Provision of study materials or patients: M.L. Brown, C.N. Klabunde.

Obtaining of funding: M.L. Brown, C.N. Klabunde.

Administrative, technical, or logistic support: M.L. Brown, C.N. Klabunde.

Collection and assembly of data: M.L. Brown, C.N. Klabunde.

Related articles in Annals:

Summaries for Patients
National Survey of Doctors' Beliefs about How Frequently Colonoscopy Should Be Done after Removal of a Colon Polyp

Annals 2004 141: I-22. [Full Text]  

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