Background. Appropriate recommendations for a followup exam after an index colonoscopy are an important quality indicator. Lack of knowledge of polyp pathology at the time of colonoscopy may be one reason that followup recommendations are not made. Aim. To describe and compare the accuracy of followup recommendations made at colonoscopy based on the size and number of polyps with recommendations made at a later date based on actual polyp pathology. Methods. All patients who underwent screening and surveillance colonoscopy from March, 2012, to August, 2012, were included. Surveillance recommendations from the endoscopy reports were graded as “accurate” or “not accurate” based on the postpolypectomy surveillance guidelines established by US Multisociety Task Force on Colon Cancer. Polyp pathology was then used to regrade the surveillance recommendations. Results. Followup recommendations were accurate in 759/884 (86%) of the study colonoscopies, based upon size and number of polyps with the assumption that all polyps were adenomatous. After incorporating actual polyp pathology, 717/884 (81%) colonoscopies had accurate recommendations. Conclusion. In our practice, the knowledge of actual polyp pathology does not change the surveillance recommendations made at the time of colonoscopy in the majority of patients. 1. Introduction Postpolypectomy surveillance constitutes 20% of the colonoscopies [1] performed, thereby contributing to a significant amount of health care expenditure [2, 3]. Prior to the development of postpolypectomy surveillance guidelines, which were based on the National Polyp Study in 1997, annual surveillance was a common practice. Since then, guidelines recommend the surveillance interval be based on risk of polyps found at index colonoscopy [4], rather than intense surveillance irrespective of polyp type. In 2006, the US Multisociety Task Force on colorectal cancer (USMSTF) issued postpolypectomy surveillance guidelines [4] based on number of polyps, polyp size, and pathology as shown in Table 1. Subsequently in 2012, the USMSTF added surveillance recommendations for serrated lesions to the previous guidelines [5]. Table 1: 2006 USMSTF surveillance recommendations. However several recent studies [6–8] have reported poor adherence to guidelines among gastroenterologists and primary care physicians. Lack of awareness of established guidelines [9] and intentional noncompliance due to personal preferences, as well as poor quality of bowel preparation [10] have been suggested as possible reasons for poor adherence to guidelines. Lack of polyp
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