Appropriateness of Recommendations for Surveillance Colonoscopy After Polypectomy-A Comparison of Adherence to the 2012 and 2020 USMSTF Guidelines.

Purpose: The U.S. Multi-Society Task Force (USMSTF) has recommended surveillance intervals that weigh the benefits, harms, and costs of colonoscopy. In 2020, it updated its screening recommendations, and we want to evaluate clinical practice adherence to recommended guideline intervals.

Methods: A prospective analysis was performed to examine gastroenterologists' recommendations for screening and surveillance colonoscopy from March 2012 to December 2023. Procedures with unknown histology or unsatisfactory bowel preparation were excluded. We compared polyp morphology, histology, and subsequent recommendations made by gastroenterologists to the USMSTF guidelines.

Results: Five hundred thirteen patients and 902 colonoscopies were included. For screening colonoscopies, 200/231 (87%) followed 2012 guidelines, while 75% followed 2020 guidelines. For 1st surveillances, 75% followed 2012 guidelines, and 50% followed 2020 guidelines (p < 0.001). Adherence was also analyzed by year from 2020 to 2023. There were no significant differences in rates for screening colonoscopy and 1st surveillances over this time frame. Since the introduction of the 2020 guidelines for screening colonoscopies, there was a decrease in adherence by 13% for low-risk adenoma (LRA) and an 8% decrease for high-risk adenoma (HRA); there was a 7% increase in adherence for hyperplastic polyps (HP) and an 11% increase in adherence with sessile serrated polyps (SSP). For 1st surveillances, there was a decrease in adherence by 16% for LRA, 11% for HRA, 1% for HP, and 2% for SSP.

Conclusions: Since the introduction of the 2020 guidelines, gastroenterologists are recommending colonoscopies more frequently than the guidelines call for. Increasing the evidence behind interval recommendations may increase guideline adherence.