Introduction Demand for colonoscopy is projected to increase by 5–10% per annum. Many units are struggling to match the demand to existing capacity. A significant proportion of endoscopy unit workload is related to follow-up colonoscopy in patients with a previous history of colorectal adenomas. Non-adherence to the BSG polyp surveillance guidelines could result in either excess demand for colonoscopy or inappropriate delays in diagnosing advanced colorectal neoplasia.
Methods We retrospectively searched the Trust's endoscopy database (catchment population 520 000) to assess our compliance to the BSG Polyp Surveillance guidelines (originally published in 2002). We chose different time periods to study including 2002, 2005–2006, 2009 (50 patients each) and 2011 (100 patients). We had previously conducted an audit in 2010 (unpublished) and following this embarked on a programme of endoscopist education to improve compliance data.
Results Compliance with the BSG Polyp Surveillance guidelines was 33% in 2002, 65% in 2005/2006, 57% in 2009 and 98% in 2011. Based on our unit's activity 3832 colonoscopies were performed in 2011 with an overall polyp detection rate of 34.6% (1325.9 colonoscopies). 98% compliance with BSG guidelines would have resulted in inappropriate advice being given in 26.5 of those colonoscopies. For every 10% reduction in compliance against the BSG standard (and for our unit based on 2011 figures) an additional 123.5 polyp positive colonoscopies would receice inappropriate guidance on polyp follow-up. In our experience (unpublished), inappropriate advice results in an increase in frequency of follow-up colonoscopies as endoscopists overestimate the patient's future risk of advanced colorectal neoplasia. This potentially has huge resource and organisation implications.
Conclusion We demonstrate a big improvement in compliance with the BSG polyp surveillance guidelines at our unit following a period of endoscopist education in 2010. With demand for colonoscopy projected to rise 5%–10% year on year and with limited ability to increase capacity under current financial constraints, appropriate patient selection for colonoscopy is essential. Failure to comply with the BSG guidelines has significant financial, organisational and patient implications. We recommend all units validate waiting lists for patients on a polyp surveillance programme.
Competing interests None declared.
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