Surveillance of patients treated for adenoma or colorectal cancer is intended to reduce the incidence of colorectal cancer.
Responsibility for the adherence to surveillance advice is often left to the patients and family physician.
It is not known whether this type of passive policy affects the efficacy of surveillance.
Dr Sanna Mulder and colleagues from the Netherlands determined the yield of surveillance without active invitation to follow-up endoscopy.
The study comprised a cohort follow-up of patients under 75 years of age with adenomas or colorectal cancer at index endoscopy from 1997 to 99.
The investigators determined adherence and intervals of follow-up endoscopy up to 2004.
|35% did not have any follow-up at all|
|Scandanavian Journal of Gastroenterology|
During the inclusion period, 2946 patients underwent lower endoscopy.
The investigators identified 393 patients.
Of these patients, 280 were newly diagnosed with colorectal polyps, and 113 with colorectal cancer.
Polyps were classified as adenomas in 61% of patients.
The investigators found that 27% of the adenoma patients underwent surveillance endoscopy within the guideline interval.
The team noted that 38% underwent delayed endoscopy.
In addition, the investigative team observed that 35% did not have any follow-up at all.
The investigators excluded from the analysis 36 patients who died during the first year or were diagnosed with metastases.
The team found that 30% of the remaining 77 patients underwent endoscopic surveillance according to the guidelines.
The investigators determined that 52% had delayed surveillance endoscopy, and 18% did not undergo surveillance endoscopy at all.
Dr Mulder's team concludes, “In surveillance for colorectal neoplasia, active follow-up invitation is important.”
“Given the low follow-up rate in our series, passive follow-up policies may lead to underperformance of surveillance programs.”
“An active and controlled follow-up is advisable.”