Concordance of surveillance colonoscopy recommended intervals with Australian guidelines: a clinical audit in six Victorian public hospitals

OBJECTIVE: Appropriate intervals for repeat (surveillance) colonoscopy are important for early colorectal cancer detection and treatment, timely patient access, and minimising patient risks. This study aimed to assess the concordance of endoscopist-recommended surveillance colonoscopy intervals with those recommended by the 2018 Australian Cancer Council surveillance colonoscopy guidelines. METHODS: Three metropolitan and three rural public hospitals in Victoria, Australia, each retrospectively audited at least 35 consecutive colonoscopy cases where the outcome recommendation was for future surveillance. The audit covered colonoscopies conducted between April 2020 and June 2021. Nurses at each hospital audited colonoscopy reports, histopathology results and other relevant patient documentation. Audit data were used to calculate the guideline-interval, which was compared with the endoscopist-recommended return interval to determine concordance. RESULTS: Of 465 consecutive colonoscopy cases audited, 248 were recommended for future surveillance colonoscopy and had complete data. A total of 25.4% (63/248) had an endoscopist-recommended interval that was consistent with the guidelines. Among discordant cases, 74.6% (n = 138) of recommendations were early; 20.5% (n = 38) were not indicated and 4.9% (n = 9) were late according to the guidelines. Excluding cases that should not return for surveillance (n = 38), concordance by guideline-recommended interval categories was 66.7% (8/12) for cases with an interval of ≤12 months, 31.0% (13/42) for 3 years, 58.3% (42/72) for 5 years and 0.0% (0/84) for 10 years. CONCLUSIONS: Guideline concordance was suboptimal at participating hospitals. Most discordant surveillance interval recommendations made were earlier than the guidelines recommend. An active, tailored approach to implementation is required given the lack of uptake several years after guideline introduction.