Colonoscopy performed too often after polypectomy
Last Updated: August 17, 2004



NEW YORK (Reuters Health) - New research suggests that many
gastroenterologists and surgeons are performing surveillance
colonoscopy after polypectomy in excess of guidelines, especially for
low-risk lesions and hyperplastic polyps.


Guidelines by the American Cancer Society and other groups recommend
colonoscopic surveillance every 3 to 5 years after a small adenoma is
removed and no follow-up if a hyperplastic polyp is resected. The
current findings, however, suggest that many physicians are
performing surveillance on a more frequent basis.

"I wasn't surprised that our findings indicated overuse, but I was
surprised by the magnitude of overuse, especially for the surgeons,"
Dr. Martin L. Brown, from the National Cancer Institute in Bethesda,
Maryland, told Reuters Health. Because colonoscopy is "principally
what gastroenterologists do, they may be more focused on guidelines
than surgeons who do a lot of other things."

The findings, which appear in the Annals of Internal Medicine for
August 17, are based on a study of 349 gastroenterologists and 316
general surgeons who were surveyed about their use of surveillance
colonoscopy after polypectomy in an average-risk patient. Eighty-
three percent of subjects responded to the survey, including 317
gastroenterologists and 125 general surgeons.

Contrary to guidelines, 24% of gastroenterologists and 54% of
surgeons recommended surveillance for a hyperplastic polyp, the
researchers found. For a small adenoma, more than 50% of respondents
recommended colonoscopic evaluation every 3 years or more often.

When asked about the basis for their surveillance beliefs, only half
of the respondents described guidelines as being very influential. In
contrast, 83% of respondents said that published evidence was very
influential.

"The results of our study provide an opportunity for policymakers and
professional societies to examine the role and influence of clinical
practice guidelines in the medical community and to consider
promoting improved guideline understanding, consensus, and
implementation," the researchers conclude.





----------------------------------------------------------------------
----------

This online resource is supported by: Sanofi-Synthelabo
www.asco.org c Copyright 2002 American Society of Clinical Oncology
All rights reserved worldwide