Time trends in post-polypectomy surveillance guideline adherence: analysis of over 90 000 colonoscopies with polypectomy

Abstract

Background

Previous studies found poor adherence to guidelines on post-polypectomy care. We aimed to investigate adherence to the European Society of Gastrointestinal Endoscopy (ESGE) recommendations before and after publication of the updated guideline in 2020, stratified by polyp type.

Methods

Participants undergoing screening documented in the Austrian Quality Certificate for Screening Colonoscopy program were included in the study. Piecewise linear regression with one breakpoint was applied to investigate trends in guideline adherence. A mixed-effects logistic regression model was fitted to investigate the associations of screening participant and endoscopist characteristics with guideline adherence.

Results

Between August 2020 and November 2024, adherence to the post-polypectomy guideline increased by 49% (95%CI 19%–86%). The strongest improvement in surveillance interval adherence was observed for adenomas (38.4% in 2020 vs. 51.2% in 2024); adherence for serrated polyps only marginally improved (52.4% in 2020 vs. 54.3% in 2024). There was a positive association between endoscopists’ adenoma detection rate (ADR) and the probability of adherence to the ESGE guideline for surveillance of high risk polyps; however, the effect size was only modest (odds ratio 1.01, 95%CI 1.00–1.03).

Conclusions

An improvement of up to 49% in ESGE guideline adherence was observed over 4 years after publication of the update, which was mostly driven by improved adherence to the surveillance intervals for adenomas. Endoscopists with higher ADRs were more likely to assign correct follow-up intervals.

Publikationsverlauf

Eingereicht: 07. März 2025

Angenommen nach Revision: 25. August 2025

Artikel online veröffentlicht:
10. Oktober 2025

• References

• 1 Click B, Pinsky PF, Hickey T. et al. Association of colonoscopy adenoma findings with long-term colorectal cancer incidence. JAMA 2018; 319: 2021-2031
• 2 Lee JK, Jensen CD, Levin TR. et al. Long-term risk of colorectal cancer and related death after adenoma removal in a large, community-based population. Gastroenterology 2020; 158: 884-894.e885
• 3 Duvvuri A, Chandrasekar VT, Srinivasan S. et al. Risk of colorectal cancer and cancer related mortality after detection of low-risk or high-risk adenomas, compared with no adenoma, at index colonoscopy: a systematic review and meta-analysis. Gastroenterology 2021; 160: 1986-1996.e3
• 4 Wieszczy P, Kaminski MF, Franczyk R. et al. Colorectal cancer incidence and mortality after removal of adenomas during screening colonoscopies. Gastroenterology 2020; 158: 875-883.e875
• 5 Cross AJ, Robbins EC, Pack K. et al. Long-term colorectal cancer incidence after adenoma removal and the effects of surveillance on incidence: a multicentre, retrospective, cohort study. Gut 2020; 69: 1645
• 6 Atkin W, Wooldrage K, Brenner A. et al. Adenoma surveillance and colorectal cancer incidence: a retrospective, multicentre, cohort study. Lancet Oncol 2017; 18: 823-834
• 7 Pinsky PF, Schoen RE. Contribution of surveillance colonoscopy to colorectal cancer prevention. Clin Gastroenterol Hepatol 2020; 18: 2937-2944.e2931
• 8 Hassan C, Antonelli G, Dumonceau JM. et al. Post-polypectomy colonoscopy surveillance: European Society of Gastrointestinal Endoscopy (ESGE) Guideline – update 2020. Endoscopy 2020; 52: 687-700
• 9 Hassan C, Quintero E, Dumonceau JM. et al. Post-polypectomy colonoscopy surveillance: European Society of Gastrointestinal Endoscopy (ESGE) Guideline. Endoscopy 2013; 45: 842-851
• 10 van Heijningen E-MB, Lansdorp-Vogelaar I, Steyerberg EW. et al. Adherence to surveillance guidelines after removal of colorectal adenomas: a large, community-based study. Gut 2015; 64: 1584
• 11 Djinbachian R, Dubé A-J, Durand M. et al. Adherence to post-polypectomy surveillance guidelines: a systematic review and meta-analysis. Endoscopy 2019; 51: 673-683
• 12 Kaminski MF, Thomas-Gibson S, Bugajski M. et al. Performance measures for lower gastrointestinal endoscopy: a European Society of Gastrointestinal Endoscopy (ESGE) Quality Improvement Initiative. Endoscopy 2017; 49: 378-397
• 13 Gessl I, Waldmann E, Britto-Arias M. et al. Surveillance colonoscopy in Austria: are we following the guidelines?. Endoscopy 2018; 50: 119-127
• 14 Meester RGS, Lansdorp-Vogelaar I, Winawer SJ. et al. High-intensity versus low-intensity surveillance for patients with colorectal adenomas. Ann Intern Med 2019; 171: 612-622
• 15 Waldmann E, Penz D, Šinkovec H. et al. Interval cancer after colonoscopy in the Austrian National Screening Programme: influence of physician and patient factors. Gut 2021; 70: 1309-1317
• 16 Goodwin JS, Singh A, Reddy N. et al. Overuse of screening colonoscopy in the Medicare population. Arch Intern Med 2011; 171: 1335-1343
• 17 Huppertz J, Coriat R, Leblanc S. et al. Application of ANAES guidelines for colonoscopy in France: a practical survey. Gastroenterol Clin Biol 2010; 34: 541-548
• 18 Mulder SA, Ouwendijk RJ, van Leerdam ME. et al. A nationwide survey evaluating adherence to guidelines for follow-up after polypectomy or treatment for colorectal cancer. J Clin Gastroenterol 2008; 42: 487-492
• 19 Mysliwiec PA, Brown ML, Klabunde CN. et al. Are physicians doing too much colonoscopy? A national survey of colorectal surveillance after polypectomy. Ann Intern Med 2004; 141: 264-271
• 20 Saini SD, Nayak RS, Kuhn L. et al. Why don't gastroenterologists follow colon polyp surveillance guidelines?: results of a national survey. J Clin Gastroenterol 2009; 43: 554-558
• 21 Dong J, Wang LF, Ardolino E. et al. Real-world compliance with the 2020 U.S. Multi-Society Task Force on Colorectal Cancer polypectomy surveillance guidelines: an observational study.. Gastrointest Endosc 2023; 97: 350-356.e353
• 22 Radaelli F, Paggi S, Bortoli A. et al. Overutilization of post-polypectomy surveillance colonoscopy in clinical practice: a prospective, multicentre study. Dig Liver Dis 2012; 44: 748-753
• 23 Patel N, Tong L, Ahn C. et al. Post-polypectomy guideline adherence: importance of belief in guidelines, not guideline knowledge or fear of missed cancer. Dig Dis Sci 2015; 60: 2937-2945
• 24 Shah TU, Voils CI, McNeil R. et al. Understanding gastroenterologist adherence to polyp surveillance guidelines. Am J Gastroenterol 2012; 107: 1283-1287
• 25 Schoen RE, Pinsky PF, Weissfeld JL. et al. Utilization of surveillance colonoscopy in community practice. Gastroenterology 2010; 138: 73-81
• 26 Li D, Doherty AR, Raju M. et al. Risk stratification for colorectal cancer in individuals with subtypes of serrated polyps. Gut 2022; 71: 2022
• 27 van der Meulen MP, Korfage IJ, van Heijningen EB. et al. Interpretation and adherence to the updated risk-stratified guideline for colonoscopy surveillance after polypectomy – a nationwide survey. Endosc Int Open 2020; 8: E1405-e1413
• 28 Sanaka MR, Super DM, Feldman ES. et al. Improving compliance with postpolypectomy surveillance guidelines: an interventional study using a continuous quality improvement initiative. Gastrointest Endosc 2006; 63: 97-103
• 29 Leffler DA, Neeman N, Rabb JM. et al. An alerting system improves adherence to follow-up recommendations from colonoscopy examinations. Gastroenterology 2011; 140: 1166-1173.e1–3
• 30 Sint Nicolaas J, de Jonge V, Cahen DL. et al. Awareness of surveillance recommendations among patients with colorectal adenomas. Clin Gastroenterol Hepatol 2012; 10: 405-411
• 31 Ransohoff DF, Yankaskas B, Gizlice Z. et al. Recommendations for post-polypectomy surveillance in community practice. Dig Dis Sci 2011; 56: 2623-2630