Non-Adherence to Colorectal Polyp Surveillance Guidelines: Magnitude and Factors Associated With Non-Adherence in an Open Access Colonoscopy Screening Program at an Academic Institution

Introduction: Colonoscopy plays a critical role in preventing colorectal cancer. The surveillance colonoscopy interval is recommended based on post-polypectomy surveillance guidelines. Adherence to these guidelines is advocated as a quality indicator, as these ensure adequate resource allocation and minimize risk from over screening. The aim of our study was to assess the rate of adherence to surveillance guidelines in an open access screening program and identify factors leading to non-adherence. Methods: Average risk patients who had 2 consecutive colonoscopies (second colonoscopy in 2019) at our institution were identified. Baseline characteristics, index findings including cecal intubation, bowel prep quality, number/size of polyps, and recommended date for surveillance were reviewed. The pathology of resected polyps was reviewed with subsequent changes to the recommended surveillance interval identified. Adherence was based on the 2012 US Multi-Society Task Force recommendations. Deviation of more than 6 months was considered non-adherence. Factors leading to non-adherence were identified. Results: 769 patients had 2 consecutive colonoscopies: 47.5% were adherent to guidelines. For the cohort that were non-adherent, 73% had their surveillance colonoscopy earlier and 27% had their colonoscopy later than recommended per guidelines. Baseline characteristics and colonoscopy quality indices between both groups were similar (Table 1). After pathology review, the recommendation for repeat colonoscopy interval changed in 64.2% of patients in the non-adherent vs 33.4% in the adherent group (P < 0.001). The change was primarily due to findings of non-neoplastic polyps (e.g., hyperplastic) in the non-adherent vs adherent group (29.9% vs 5.2%, P < 0.001). The mean was 3.1 years (SD 1.9) outside the recommended lower limit for early patients, and 1.8 years (SD 1.6) outside the upper recommended limit for late patients. The most common reason for non-adherence among early patients was the endoscopist not updating the interval after pathology review (56.9%) vs patient non-compliance or poor health status (36.7%) among late patients (Figure 1). Conclusion: Nonadherence to surveillance colonoscopy guidelines was observed in 52.5% of patients in our cohort, with the majority receiving an earlier colonoscopy, primarily due to lack of an updated surveillance interval after pathology review. Colonoscopy surveillance programs should monitor adherence rate and consider steps to improve factors leading to non-adherence. Table 1. - Characteristics in the Adherent vs Non-adherent Groups Adherent (n = 365) Non-adherent (n = 404) Total (n = 769) Age at 2019 colonoscopy: mean (SD) 66.5 (7.4) 65.7 (8.3) 66.1 (7.9) Gender (male) 222 (60.8%) 216 (53.5%) 438 (57.0) Race American Indian/Alaska Native 2 (0.5%) 1 (0.2%) 3 (0.4%) Asian 13 (3.6%) 10 (2.5%) 23 (3.0%) Black or African American 3 (0.8%) 8 (2.0%) 11 (1.4%) Choose Not to Disclose/Unknown 2 (0.5%) 4 (1.0%) 6 (0.8%) Other 4 (1.1%) 7 (1.7%) 11 (1.4%) White 341 (93.4%) 374 (92.6%) 715 (93.0%) Ethnicity Choose Not to Disclose/Unknown 7 (1.9%) 10 (2.5%) 17 (2.2%) Hispanic or Latino 15 (4.1%) 20 (5.0%) 35 (4.6%) Not Hispanic or Latino 343 (94.0%) 374 (92.6%) 717 (93.2%) Index Colonoscopy Characteristics Cecum reached 358 (99.4%) 401 (99.5%) 759 (99.5%) BBPS: mean (SD) 6.8 (1.3) 6.8 (1.2) 6.8 (1.2) Number of polyps detected: mean (SD) 2.6 (2.3) 2.1 (2.0) 2.3 (2.2) Recommendation Change to Interval Colonoscopy Based on Pathology 114 (33.4%) 253 (64.2%) 267 (49.9%) Figure 1.: Factors resulting in non-adherence to the recommended surveillance guidelines.