Use of Screening and Surveillance Colonoscopy in a Community Teaching Hospital

Abstract

Introduction: To determine the frequency of inappropriate colonoscopies performed for CRC screening and surveillance in a community teaching hospital. Methods: Between January 2013 and May 2013, all outpatient colonoscopies performed in a community teaching hospital were retrospectively reviewed. Inclusion criteria included: 1.) patients above the age of 18. 2.) Colonoscopies done for CRC screening or surveillance purposes. Colonoscopies performed for surveillance of inflammatory bowel disease, abdominal pain, gastrointestinal bleeding, or anemia were excluded. Appropriateness of each procedure was established by 2 independent reviewers (ZK, DB) according to the guidelines of the U.S. Multi-Society Task Force on Colorectal Cancer. Any discrepancy between the reviewers was decided by a third independent reviewer (DW). Each colonoscopy and corresponding pathology report was reviewed for clinically significant outcomes and for the documentation of preparation quality. These items were included as part of our analysis. Clinically significant outcomes of colonoscopies were defined as finding of CRC, adenoma, and/or colitis. Results: Between January 2013 and May 2013, 7 endoscopists performed 1187 colonoscopies for various indications. Of those, 953 colonoscopies were done for screening (n=556) and surveillance (n=397) for CRC. Four records were excluded for insufficient information. The average age of patients included our study was 59 (range 32-88). Forty-two percent of patients were males. In this study, a total of 184 (19.3%) procedures were classified as inappropriate. Seven hundred sixty-five procedures (80.6%) were performed for the appropriate indication and at the appropriate time interval. Of the colonoscopies that were done for screening purposes, 13 out of the 556 were classified as inappropriate (2.3%) and 171 out 393 (43.5%) of the surveillance procedures were classified as inappropriate. In this study, 115 clinically significant findings were captured from the 765 appropriate colonoscopies (15.0%), and 16 out of the 184 procedures that were inappropriate (8.7%). Conclusion: Among patients at a community teaching hospital, we found that almost one out of five colonoscopies performed for CRC screening and surveillance purposes were inappropriate according to published guidelines; however, 8.7% of the inappropriate colonoscopies lead to clinically significant findings. Strict adherence to guidelines may lead to missed opportunities to detect interval cancers and lead to increased overall morbidity and mortality for some patients.Table 1