A Systematic Review on the Effectiveness of Clinician-Directed Interventions to Improve Compliance to Post-Polypectomy Surveillance Guidelines

Introduction: Clinical practice guidelines recommend periodic colonoscopy surveillance following colorectal adenoma excision. Inappropriate use of post-polypectomy surveillance (PPS) is common and lead to improper resource utilization. The aim of this review was to identify structured interventions which can affect PPS practises and to evaluate the effectiveness of these various interventions in improving clinician adherence to PPS guidelines. Methods: A computerized search was performed to identify relevant studies between 1997 and November 2020. Two investigators identified eligible studies and extracted data independently. The quality of the included studies was assessed by the Newcastle-Ottawa risk of assessment scoring system. Results: The search identified 5,602 citations. Forty-one articles were retrieved for full-text analysis and 7 studies met the inclusion criteria. Compliance to PPS guidelines was higher following interventions which included medical education, specialist nurse coordinators facilitation, continuous quality improvement, and clinical decision support systems. Conclusion: This study demonstrates that medical education, specialist nurse coordinators, continuous quality improvement, and clinical decision support systems are effective in improving clinicians' compliance to PPS guidelines, and are associated with reduction in over- and underutilization of colonoscopy surveillance resources.