Retrospective Cohort Study: Scope for Improvement—Barriers to Post-Polypectomy Surveillance in the Integrated Technologies for Improved Polyp Surveillance Cohort

Abstract

Background

Adherence to post-polypectomy surveillance is poor despite evidence that it is associated with lower risk of future colorectal cancer.

Methods

We evaluated 6,210 bowel screening participants between 2009-2016 in NHS Greater Glasgow and Clyde to assess potential barriers to post-polypectomy surveillance.

Results

Increasing deprivation (Scottish Index of Multiple Deprivation quintile 1 vs 5; OR 1.68; p < 0.001), and increasing comorbidity (Charlson Comorbidity Index 1-2 vs 3-4; OR 1.80; p < 0.001, vs ≥ 5; OR 3.31; p < 0.001), were associated with non-surveillance in British Society of Gastroenterology 2002 intermediate/high-risk patients, while ACE-Inhibitor (OR 0.78; p < 0.001) and aspirin use (OR 0.34; p < 0.001) were associated with undergoing surveillance. The most deprived patients receiving surveillance had more metachronous polyps (54.0% vs 49.3%) and cancer (1.1% vs 0.4%) (p = 0.044).

Discussion

Patients from more socioeconomically deprived areas are less likely to have appropriate post-polypectomy surveillance, and are more likely to have metachronous polyps and colorectal cancer even when they do.

Conclusion

Surveillance strategies must take into account factors including socioeconomic deprivation and comorbidity exist to improve surveillance uptake in this group through the design of targeted interventions which move away from the current “one size fits all” approach.