2843 Lack of Knowledge About Follow-Up Colonoscopy in Patients With Biopsy Proven Advanced Colorectal Polyps: A Major Clinical and Medicolegal Challenge

Abstract

INTRODUCTION: The most recent guidelines from the American College of Gastroenterology recommend that patients with biopsy proven advanced colorectal polyps undergo repeat surveillance colonoscopy at a minimum of three years following resection. The rationale is based on rates of recurrence and progression to colorectal cancer. In this report we quantitate the knowledge of patients with biopsy proven advanced colorectal polyps about if, and when, they need a repeat colonoscopy. METHODS: Methods: Written informed consents were obtained and brief telephone interviews conducted by trained interviewers among 84 patients with biopsy proven advanced colorectal polyps. In semi-structured questionnaires that included eleven questions the patients provided self-reports about their awareness of the need to have a repeat colonoscopy as well as the proper surveillance interval. RESULTS: Among the 84 patients, who ranged in age from 41-91 years, 24 (28.6%) were unaware of either the need for a repeat colonoscopy or the proper surveillance interval. These included 10 (12.0%) who were not even aware that they required a follow up colonoscopy and 14 (16.6%) who were unaware of the proper three year interval. CONCLUSION: Discussion: These data pose medical and legal challenges to clinicians to educate patients with biopsy proven advanced colorectal polyps about their need for repeat colonoscopy as well as the proper surveillance interval to reduce their risks of colorectal cancer. Specifically, without proper knowledge of the advanced colorectal polyp three year surveillance protocol, 28.6% of these high risk patients would have forgone or delayed the colonoscopy. With advances in technology and digitized medical records, clinicians may need to rely on a more objective and reproducible centralized database of past colonoscopy findings rather than self-reports. These clinical and medicolegal challenges may also be addressed, at least in part, by automated recalls that ensure there is a safety net to remind patients of their subsequent colonoscopy appointment. The success of these strategies will depend on meticulous attention by the clinician to ensure accurate data pertaining to guideline based appropriate surveillance intervals for colonoscopy. These strategies may also reduce any overutilization of colonoscopies. Of far greater import, the achievement of this goal may reduce morbidity and mortality from colorectal cancer in high risk patients with advanced colorectal polyps.