Introduction The BSG adenoma follow up (FU) guideline is widely recognised and implemented in Endoscopy practice. It is anecdotally noted that adherence to guideline is poor due to non-adenoma polypectomy and/or misinterpretation. This has significant clinical implications for patients and financial implications for the NHS. We aim to evaluate adherence to guideline by conducting a large multi-centre audit.
Method 1100+ polypectomies from 2010 (chosen as index year to allow evaluation of 5+ year FU intervals) performed at four endoscopy departments at University Hospitals Leicester and Kettering General Hospital NHS trusts, by a large number of operators, were analysed by interrogating endoscopy and histology reports and collated in a database, endoscopy FU intervals were compared to BSG guidance.
Results FU data were discarded if not clear, terminated by clinician or confounded by other diseases. Overall 854 polypectomies were analysed. FU was classed as appropriate if performed <18 months for high risk adenomas (excluding polyp base checks), 24 ->48 months for intermediate risk adenomas and 48–72 months for low risk adenomas.
Conclusion There are potential confounders when interpreting the data; the guidance allows those with low risk adenomas to be discharged and upgrades FU for patients who have had high risk adenomas previously, also patient factors such as not being fit for FU and not wanting or attending FU. Adherence ranges from 62.31% for high risk adenomas to 11.85% of low risk adenomas, overall adherence to the guideline is only 32.44%. 44.03% alarmingly had no FU at all (range from 23.85% of high risk adenomas to 59.54% of low risk adenomas). Only 3.86% of FU was delayed. For intermediate and low risk adenomas, 23.20% of FU was performed too early.
The data suggests adherence to BSG guidance is suboptimal and could be improved with robust protocols of validation of referrals, and safeguards. The ramifications for patients with adenomas (especially high risk) without appropriate FU are increased morbidity and cancer. Poor compliance to the guideline has financial implications to a department when>20% of procedures are performed too early. Poor adherence is a greater problem in the symptomatic service as the bowel cancer screening programme FU is tightly regulated.
. SR Cairns, JH Scholefield, RJ Steele, et al. Guidelines for colorectal cancer screening and surveillance in moderate and high risk groups (update from 2002). Gut2010;59:666–690.
Disclosure of Interest None Declared