A214 ADHERENCE TO COLONOSCOPY SURVEILLANCE GUIDELINES: A SYSTEMATIC REVIEW AND META-ANALYSIS
Bibliographic record
Abstract
Colorectal cancer (CRC) is a major worldwide cause for cancer related mortality. Colonoscopy-based population screening programs based on guideline recommended surveillance intervals have been put in place to reduce the morbidity and mortality associated with CRC. To evaluate clinical practice adherence to surveillance colonoscopies guideline recommendations, the potential extent of early repeat colonoscopies, and causes for non-adherence to guideline recommendations. MEDLINE, EMBASE, EBM Reviews, and CINAHL databases were searched up to January 2018 for articles reporting on guideline adherence for surveillance colonoscopies. Original clinical studies reporting patient outcomes were included if they excluded inflammatory bowel disease and hereditary CRC syndrome cohorts. Eligibility was assessed by two different researchers and conflicts were resolved through a third researcher. Primary outcome was correct surveillance interval assignment in patients undergoing screening or surveillance colonoscopy. Groups were assessed for adherence according to their respective guideline recommendations (North American or European). Eighteen studies were included in the analysis. The mean colonoscopy surveillance interval adherence rate was 48.8% (95% CI, 37.3–60.4). Adherence to clinical indications for performing colonoscopies was 66.5% (95% CI, 52.7–79.0). For North American guidelines, surveillance interval assignments after detection of low-risk lesions were adherent to recommendations in 44.7% (95% CI, 24.2–66.3) of patients; shorter in 52.4% (95% CI, 31.5–72.8); longer in 1.4% (95% CI, 0.00–5.82). After detection of high-risk lesions, 54.6% (95% CI, 41.4–67.4) of surveillance intervals were adherent to recommendations; 30.8% (95% CI, 22.7–39.5) were shorter; 14.7% (95% CI, 4.0–30.0) were longer. For European guidelines, surveillance interval assignments after detection of low-risk lesions were adherent to recommendations in 24.4% (95% CI, 1.1–63.4) of patients; shorter in 61.2% (95% CI, 43.8–77.2); longer in 0.7% (95% CI, 0.0–4.1). After detection of high-risk lesions, 73.6% (95% CI, 35.5–98.8) of surveillance intervals were adherent to recommendations; 0% (95% CI, 0.0–0.4) were shorter; 16.1 (95% CI, 2.4–36.5) were longer. The worldwide adherence to surveillance colonoscopy guidelines is low with more than 50% of patients undergoing too early or too late repeat colonoscopies. Early repeat colonoscopies occur with the highest frequency in patients in whom only hyperplastic polyps or low-risk adenomas are found. Reasons cited for non-adherence included disagreement with the guidelines, endoscopist concern for missed polyps, poor bowel preparation, malpractice concerns, and reimbursement reasons. Percentage of adherence to surveillance intervals None
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.003 | 0.002 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.009 | 0.003 |
| Bibliometrics | 0.001 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".