SNFGE SNFGE
 
Thématique :
- Endoscopie/Imagerie
- Cancer colorectal (CCR)
Originalité :
Intermédiaire
Solidité :
Intermédiaire
Doit faire évoluer notre pratique :
Pas encore
 
 
Nom du veilleur :
Professeur Emmanuel CORON
 
 
Gut
  2015/10  
 
  2015 Oct;64(10):1584-92  
  doi: 10.1136/gutjnl-2013-306453  
 
  Adherence to surveillance guidelines after removal of colorectal adenomas: a large, community-based study  
 
  van Heijningen EM, Lansdorp-Vogelaar I, Steyerberg EW, Goede SL, Dekker E, Lesterhuis W, Ter Borg F, Vecht J, Spoelstra P, Engels L, Bolwerk CJ, Timmer R, Kleibeuker JH, Koornstra JJ, de Koning HJ, Kuipers EJ, van Ballegooijen M.  
  http://www.ncbi.nlm.nih.gov/pubmed/25586057  
 
 

OBJECTIVE:

To determine adherence to recommended surveillance intervals in clinical practice.

DESIGN:

2997 successive patients with a first adenoma diagnosis (57% male, mean age 59 years) from 10 hospitals, who underwent colonoscopy between 1998 and 2002, were identified via Pathologisch Anatomisch Landelijk Geautomatiseerd Archief: Dutch Pathology Registry. Their medical records were reviewed until 1 December 2008. Time to and findings at first surveillance colonoscopy were assessed. A surveillance colonoscopy occurring within ±3 months of a 1-year recommended interval and ±6 months of a recommended interval of 2 years or longer was considered appropriate. The analysis was stratified by period per change in guideline (before 2002: 2-3 years for patients with 1 adenoma, annually otherwise; in 2002: 6 years for 1-2 adenomas, 3 years otherwise). We also assessed differences in adenoma and colorectal cancer recurrence rates by surveillance timing.

RESULTS:

Surveillance was inappropriate in 76% and 89% of patients diagnosed before 2002 and in 2002, respectively. Patients eligible under the pre-2002 guideline mainly received surveillance too late or were absent (57% of cases). For patients eligible under the 2002 guideline surveillance occurred mainly too early (48%). The rate of advanced neoplasia at surveillance was higher in patients with delayed surveillance compared with those with too early or appropriate timed surveillance (8% vs 4-5%, p<0.01).

CONCLUSIONS:

There is much room for improving surveillance practice. Less than 25% of patients with adenoma receive appropriate surveillance. Such practice seriously hampers the effectiveness and efficiency of surveillance, as too early surveillance poses a considerable burden on available resources while delayed surveillance is associated with an increased rate of advanced adenoma and especially colorectal cancer.

 
Question posée
 
Il existe de toute évidence une différence entre les recommandations européennes pour la surveillance post-coloscopie et le suivi de ces recommandations en pratique, mais quelle est l’importance de cette différence ?
 
Question posée
 
Cette étude hollandaise, quoique plus ancienne que l’étude italienne de Zorzi et al., aboutit aux même conclusions, à savoir qu’un grand nombre de patients (76% à 89% selon la période étudiée ici !) reçoivent des recommandations inadaptées en terme de surveillance post-coloscopie. L’impact de cette méconnaissance des règles de surveillance est important avec soit un risque de survenue de cancer colorectal en cas de surveillance retardée ou absente, soit une surcharge bien réelle du système de santé en cas de surveillance excessive.
 
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