Colonoscopy in Austria and the American guidelines: A comparison

Introduction: If in the process of a basic colonoscopy adenomas were found, the risk of developing new ones is high. Hence, the patients need an accurate follow-up colonoscopy after polypectomy of adenomas. The American guidelines, published in 2008 (American Cancer Society; Gastroenterology 2008; 134:1570–1595), established a set of terms to define an interval of follow-up colonoscopy based on the numbers and size of adenomas found and their corresponding histological characteristics. Given that in Austria are no published guidelines we intended to assess to what extent Austrian endoscopists are referring to the American directive. Methods: Within the scope of the Austrian Society for Gastroenterology and Hepatology (ÖGGH) Project “certificate of quality for screening colonoscopy“, we collected data from 22,669 patients from 157 endoscopic units. According to the American guidelines follow-up colonoscopy should be scheduled based on the following criteria: several small hyperplastic polyps in 10 years, 1 to 2 small tubular adenomas (<1cm) with low grade dysplasia (LGD) in 5 to 10 years, 3 to 10 adenomas >1cm or villous adenomas in 3 years, high grade dysplasia (HGD) adenomas and entire ablation in 3 years, more than 10 adenomas in 1 to 3 years and flat and broad based adenomas in 2 to 6 months. Results: The 157 endoscopists recommend follow-up colonoscopies as follows: several small hyperplastic polyps: 3.3% of the participants recommend treatment after 10 years, whereas the majority (25.3%) carry out treatment after 5 to 10 years; 1 to 2 small tubular adenomas (<1cm) with LGD: 16.8% recommend treatment after 5 years, the majority of 46.9% carry out treatment after 3 years; single adenoma >1cm or a villous adenoma: the majority of 27.3% are following the guideline (i.e. 3 years); HGD adenomas and entire ablation: the majority of 34% are following the guideline (i.e. 2–6 months). Conclusion: Austrian endoscopists are following the American guidelines in 17.7%. In Austria everything points to shortened intervals of follow-up colonoscopies compared to guidelines. Even though criteria like age, comorbidity, reduced visibility, compliance of the patient and family predisposition could lead to different recommendations. The American guidelines should be taken as a minimal standard to assure a high level of care.