Adherence to Low-Risk Adenoma Recommendations From 2020 U.S. Multi-Society Task Force Postpolypectomy Guideline Has Not Yet Caught On
Douglas K. Rex, MD, MASGE, reviewing Dong J, et al. Gastrointest Endosc 2022 Aug 20.
The U.S. Multi-Society Task Force on Colorectal Cancer (USMSTF) creates postpolypectomy surveillance interval recommendations for the U.S. The main change to the 2020 guideline was for patients with low-risk adenomas (LRAs) to undergo next surveillance at 7 to 10 years rather than the 5 to 10 years recommended in the 2012 guideline.
In a single U.S. center, guideline adherence was measured in a baseline period from November 2019 to January 2020 and then in postguideline periods of March 2021 to May 2021, November 2021 to January 2022, and April 2022 to May 2022. Only first-time screening colonoscopies were considered.
Postguideline adherence for patients with LRAs was 18.6%, whereas adherence for high-risk adenomas was 90.4%, sessile serrated lesions was 65.9%, and hyperplastic polyps was 89.1%. There was no increase in adherence over the 3 time periods for LRAs.
Nineteen of the 33 participating endoscopists completed a survey for which only 10 (52.6%) provided the correct answer to a vignette about 1 small tubular adenoma, and 7 (36.8%) provided the correct answer regarding 2 small LRAs. LRA adherence was higher in those who responded to at least one of the LRA vignettes included in the survey, but adherence was only 18.6% (8 of 43 cases) within this group.
Nonadherence was associated with endoscopists who finished training more than 10 years ago (odds ratio [OR], 1.7) and endoscopists who perform more than 800 colonoscopies per year (OR, 2.0). Among 211 LRA cases in which endoscopists did not adhere to the 2020 guideline, the 2012 guideline was followed in 201 cases (95.3%).
COMMENTThese data indicate that there is both a knowledge gap regarding the specifics of the 2020 UMSTF recommendations and an unwillingness to accept the recommendations, at least at this single U.S. academic center. One potential explanation is that these changes simply take time to incorporate since 95% of the actual procedural recommendations were at least consistent with the 2012 recommendations. Endoscopists skeptical of moving to 7-year surveillance intervals for patients with low-risk adenomas should remember that colonoscope technology and adenoma detection rates have progressively improved over the past decade. Further, the rest of the world has already moved to a recommendation of surveillance every 10 years or return to screening for LRAs.
Note to readers: At the time we reviewed this paper, its publisher noted that it was not in final form and that subsequent changes might be made.
CITATION(S)
Dong J, Wang LF, Ardolino E, Feuerstein JD. Real-world adherence to the 2020 United States Multi-Society Task Force polypectomy surveillance guidelines: an observational study. Gastrointest Endosc 2022 Aug 20. (Epub ahead of print) (https://doi.org/10.1016/j.gie.2022.08.020)
