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Post-Polypectomy Surveillance Deborah A. Fisher, MD, MHS Associate Professor of Medicine Duke University Medical Center Durham, North Carolina, USA March 12, 2011
Outline ,[object Object],[object Object],[object Object],[object Object]
Reminder: Surveillance ,[object Object]
EU guiding principals ,[object Object],[object Object],[object Object],[object Object],[object Object]
EU recommendations: adenoma surveillance ,[object Object],[object Object],[object Object],[object Object],[object Object]
EU guideline
EU recommendations: piecemeal resection ,[object Object],[object Object],[object Object]
EU recommendations: other considerations ,[object Object],[object Object],[object Object],[object Object]
Opportunity costs ,[object Object],[object Object],[object Object],[object Object]
Quality in receipt of medical services ,[object Object],[object Object],[object Object]
More is not always good
Overuse: Why more is not better ,[object Object],[object Object],[object Object],[object Object]
US: Physician recommended overuse ,[object Object],[object Object],[object Object],[object Object],Mysliwiec  Ann Intern Med  2004; Boolchand  Ann Intern Med  2006
US: Receipt of surveillance for adenomas ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Schoen  Gastroenterol  2010;  Siddiqui  APT  2006
UK: Adherence to 2002 BSG guidelines  on the colonoscopy wait list Pickard  Colorectal Dis  2006; Shoaib  Colorectal Dis  2006; Selinger GUT 2005 ; John  Colorectal Dis 2008 Overuse Underuse Thomas 2005 65% (overall) 78% (low risk) 20% 6% Picard 2006 76% NR Shaoib 2006 38% 10% John 2008 82% 0%
Overuse UK: intervention ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],John  Colorectal Dis 2008
Potential reasons for overuse ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Overuse in other countries ,[object Object],[object Object],[object Object],[object Object]
Quality and surveillance ,[object Object],[object Object]
Closing remarks ,[object Object],[object Object],[object Object],[object Object],[object Object]
 

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Endoscopy in Gastrointestinal Oncology - Slide 17 - D. Fisher - Post-polypectomy surveillance

  • 1. Post-Polypectomy Surveillance Deborah A. Fisher, MD, MHS Associate Professor of Medicine Duke University Medical Center Durham, North Carolina, USA March 12, 2011
  • 2.
  • 3.
  • 4.
  • 5.
  • 7.
  • 8.
  • 9.
  • 10.
  • 11. More is not always good
  • 12.
  • 13.
  • 14.
  • 15. UK: Adherence to 2002 BSG guidelines on the colonoscopy wait list Pickard Colorectal Dis 2006; Shoaib Colorectal Dis 2006; Selinger GUT 2005 ; John Colorectal Dis 2008 Overuse Underuse Thomas 2005 65% (overall) 78% (low risk) 20% 6% Picard 2006 76% NR Shaoib 2006 38% 10% John 2008 82% 0%
  • 16.
  • 17.
  • 18.
  • 19.
  • 20.
  • 21.  

Notas do Editor

  1. Definitions – have everyone on the same page Discussion of points in quality measurement Screening and surveillance Colonoscopy itself regardless of indication Then closing remarks
  2. On to surveillance
  3. Maybe save for polyp talk
  4. Maybe save for polyp talk
  5. Maybe save for polyp talk
  6. Maybe save for polyp talk
  7. Maybe save for polyp talk
  8. Because when we look at receipt of services vs recommendations for services we see over use and underuse
  9. Caribbean