Study Suggests Doctors Overperform Colonoscopies

Physicians In the United States appear to be performing surveillance colonoscopies more frequently than those recommended by evidence-based medical guidelines, according to a new survey.

Surveillance colonoscopies are administered to patients who have had a colorectal abnormality diagnosed and excised. These survey results, from the U.S. National Cancer Institute (NCI, Bethesda, MD, USA), were published in the August 17, 2004, issue of the Annals of Internal Medicine, and advise that as the demand for colonoscopies grows in the United States, overperformance could expend limited physician resources and cause needless risk to the patients.

The NCI researchers surveyed both general surgeons and gastroenterologists about their thoughts and practices concerning colonoscopies in a variety of clinical situations, to find out what factors most influence a physician's decisions. The goal was to find out how frequently physicians would recommend a colonoscopy and/or other procedures following initial findings of a colorectal abnormality in an asymptomatic and healthy 50-year-old patient. A physician could recommend a colonoscopy, double-barium enema, fecal occult blood testing, flexible sigmoidoscopy, or a conventional rectal exam.

The study found that both groups of physicians recommended a colonoscopy in a follow-up session at a higher frequency than guidelines would require, particularly in instances where the initial findings were thought to be low-risk. In the low-risk circumstances--a patient diagnosed with only a small, hyperplastic polyp--24% of gastroenterologists and 54% of general surgeons recommended a colonoscopy, either alone or in combination with another procedure, at a frequency of at least every five years. Among these individuals with a single, small adenoma, which is deemed to be a low-risk abnormality, the researchers reported more than one-half of physicians surveyed would recommend follow-up colonoscopy every three years or earlier.

Colonoscopies can result in complications, such as a tear in the colon wall or a reaction to sedation. For patients thought to have a low risk of colon cancer, the cumulative possibility of complications counterbalances the benefits in cancer reduction. Colonoscopies are also costly, so unnecessary follow-ups could create a financial burden on the healthcare system and on patients.




Related Links:
National Cancer Institute