Adherence to BSG adenoma surveillance guidelines will reduce colonoscopic workload

There is an ever increasing demand for colonoscopy nationally which will increase further when colorectal cancer screening is rolled out nationally. To accommodate this, a marked improvement in the efficiency of endoscopy units is required. One simple way of reducing demand is to reduce the number of repeat procedures performed. We have found that by following the British Society of Gastroenterology (BSG) polyp follow up guidelines,¹ our unit could prevent a significant number of unnecessary colonoscopies.

Our unit’s three month retrospective audit found that 79 of 528 patients undergoing colonoscopy had colonic polyps; 130 polyps in total were detected of which 65 were histologically confirmed adenomas (45 tubular, 18 tubulovillous, and two villous). Over two thirds were in the rectum/sigmoid.

By classifying patients with polyps according to BSG guidelines:

• 32 were low risk, of which 16 had too short a follow up interval and 16 had correct follow up (of the 16 with too short a follow, 10 had no follow up and six had a five year follow up);

• 13 were intermediate risk, with three having correct follow up, six too short a follow up interval, one too long a follow up, and three had no follow up;

• one patient was high risk and received too long a follow up interval;

• 11 had incomplete polyp removal of which four received appropriately rapid follow up, two had late follow up, and five received no follow up;

• of 22 patients with non-adenomatous polyps, only eight had an unnecessary repeat procedure arranged.

Strict adherence to the BSG guidelines would have added eight apparently overlooked procedures but could have saved up to 30 other surveillance procedures (if a policy of no follow up for low risk polyps was used), resulting in a net reduction of 22 procedures. This is equivalent to a 47% reduction in surveillance colonoscopies.

The simple measure of reviewing repeat requests for surveillance procedures to ensure they adhere to BSG guidelines should reduce the number of unnecessary procedures performed, creating additional capacity within our endoscopy unit and reducing the exposure of patients to unnecessary risk.