S557 Post-Polypectomy Guideline Adherence in the Post-Pandemic Era: A Systematic Review and Meta-Analysis

Introduction: The United States Multi-Society Task Force (USMSTF) updated its guidelines for surveillance intervals in 2020, introducing longer recommended intervals for low risk adenomas (LRA). The aim of this systematic review and meta-analysis is to evaluate adherence to the updated 2020 USMSTF guidelines in clinical practice. Methods: We searched PubMed, Embase, Cochrane, and Google Scholar from inception until May 2025 for studies reporting guideline adherence for surveillance colonoscopies. We specifically looked for adherence to the USMSTF 2020 guidelines update. We assessed the data for overall guideline adherence, longer and shorter surveillance intervals amongst non-adherent cases, and adherence stratified by findings of LRA, high risk adenomas (HRA), hyperplastic polyps (HP), and sessile serrated polyps (SSP). We used both a fixed and a random effects model, and the data was presented using odds ratios (OR) with 95% confidence intervals (CI). Meta-analysis of proportions was performed using R software with the metafor package. Results: A total of 3 studies totaling 2,147 cases were included in this study. Overall adherence to the 2020 USMSTF guidelines was 66.9% (95% CI 43.2-84.4). Surveillance interval was shorter than the guideline recommendations in 25% (95% CI 10.1-49.2) of cases. There were less than 10 cases where the surveillance interval was longer than recommended. For LRA, surveillance interval guideline adherence was 30.7% (95% CI 1.9-90.8). For HRA, guideline adherence was 82.7% (95% CI 67.6-91.6). For HP, guideline adherence was 70.4% (95% CI 19.1-96.0). For SSP, guideline adherence was 79.6% (95% CI 39.6-95.9). Conclusion: Surveillance interval guideline adherence has previously been reported at 48.8% for guidelines prior to the 2020 USMSTF update. This analysis found higher guideline adherence since the 2020 update to the updated guidelines at 66.9%. Guideline adherence differed by the type of lesions found during colonoscopy, with the lowest being for LRA. Most non-adherent cases involved shorter than recommended surveillance intervals. We infer that providers were less comfortable with longer surveillance intervals for LRA, resulting in shorter than recommended intervals in this group.