Timing repeat colonoscopy: disparity between guidelines and endoscopists' recommendations

Oct 31 2007

Colonoscopies are important screening tools to find colon cancers, but a recent study implies that endoscopists suggest repeat tests more often than practice guidelines recommend.

Alex Krist, M.D., assistant professor in the department of family medicine at Virginia Commonwealth University Medical Center in Richmond, and colleagues reviewed the medical charts of nearly 1,300 area patients who underwent colonoscopy.

In nearly 65 percent of the cases, the endoscopist's report to the patient's primary care physician gave specific suggestions as to when retesting should occur. Only 39 percent of these suggestions were correct according to the American Cancer Society and American Gastroenterological Association guidelines in effect at the time of the study. The endoscopists often recommended retesting at shorter intervals than guidelines suggested.

The study appears online and in the December issue of the American Journal of Preventive Medicine .

“This study highlights the need for improved communication between different groups of doctors as well as between doctors and their patients,” Krist said. “Colonoscopy is different from many other kinds of cancer screening because there are very long timeframes before retesting is needed.”

The study found that endoscopists' reports sent to primary care doctors often lacked information about the test's findings and results, which makes it difficult to ensure that patients have a repeat colonoscopy at the right time. When guidelines change –as they did in June 2006 – it compounds the problem.

It can be confusing for patients if the gastroenterologist who performed the colonoscopy makes a recommendation that clashes with that of the primary care doctor.

“This confirms earlier studies showing that people are being referred for surveillance colonoscopies more often than currently recommended,” said Reid Ness, M.D., an assistant professor of medicine at Vanderbilt University who was not involved in the study. “Follow-up colonoscopies are often prescribed more often than needed, so it is important that the patient understand what the endoscopist's recommendations are and what guidelines they are based on, and then confirm that all of this information is being transmitted to their primary care provider.”

Both physicians agreed that it is important to not waste time and money repeating studies in those people previously shown to be at low risk for colon cancer, which can take time and limited resources away from those who have not ever had the procedure.

American Journal of Preventive Medicine : Contact the editorial office at (858) 457-7292 or [email protected]

Krist AH, et al. Timing repeat colonoscopy: disparity between guidelines and endoscopists' recommendations. Am J Prev Med 33(6), 2007.