Knowledge of Colon Polyp Surveillance Guidelines and Current Practices Amongst Gastroenterologists Preparing for Certification Or Re-Certification Examinations

Abstract

Background: In 2003, the multi-society task force issued new colon polyp surveillance guidelines. A 2004 survey suggested that gastroenterologists (GI MDs) had sub-optimal knowledge of these guidelines or simply disagreed with the guideline recommendations. In May 2006, revised polyp surveillance guidelines were published. This study surveyed GI MDs preparing for board re-certification or certification regarding: (1) knowledge of new guideline recommendations; (2) frequency of disagreement with these recommendations; and, (3) current clinical practices. Methods: A multiple choice survey was developed from the 2006 multi-society guideline and underwent content validation through review by experts. For each question, respondents reviewed a clinical scenario, identified the appropriate intervention based upon the guideline recommendation, stated if they were certain about the guideline recommendation for the question, and reported their usual practice. The survey was distributed to physicians attending the two major board review courses (the Mayo Clinic GI Board Review Course and the William Steinberg Board Review Course). Results: 42% (n = 224) of potential respondents completed the survey. Respondents correctly answered 77% of questions. Of GI MDs preparing for re-certification, 90% correctly answered a question on when to repeat colonoscopy in a patient with 1 small adenoma versus 85% of GI MDs preparing for certification. Notably, only 16% of respondents disagreed with this guideline recommendation compared with nearly 30% in our 2004 survey. 35% of GI MDs did not know the guideline recommendation for surveillance colonoscopy after successful surgical resection of colon cancer. However, only 1% of respondents who knew the 2006 guideline recommendation of a 1-year interval disagreed with this recommendation, representing a marked change from our 2004 survey where >75% disagreed with the 3-year interval recommended by the 2003 guideline. If a patient had a normal screening colonoscopy with a “good” prep (approximately 10% of colonic mucosa obscured), two-thirds of GI MDs chose to repeat colonoscopy in 5 years instead of 10 years. Conclusions: Over one-third of GI MDs do not know the new recommendations in the 2006 multi-society polyp surveillance guideline. Of those that know the guidelines, few disagree with the recommended surveillance intervals for 1 small adenoma and surgically resected colon cancer. However, the majority of GI MDs continue to disregard guideline recommendations in patients with a normal screening colonoscopy and a “good” prep, opting to perform colonoscopy sooner than recommended in such patients.