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Factors that Affect Adherence to Surveillance Colonoscopy in Patients with Inflammatory Bowel Disease

Friedman, Sonia MD*; Cheifetz, Adam S. MD; Farraye, Francis A. MD; Banks, Peter A. MD*; Makrauer, Frederick L. MD*; Burakoff, Robert MD, MPH*; Farmer, Barbara BA*; Torgersen, Leanne N. MSc*; Wahl, Kelly E. MFA§

doi: 10.1097/MIB.0b013e3182802a3c
Original Clinical Article

Background: Patients with extensive ulcerative colitis or Crohn’s disease of the colon have an increased risk of colon cancer and require colonoscopic surveillance. This study explores factors that affect adherence to surveillance colonoscopy.

Methods: Three hundred and seventy-eight patients with ulcerative colitis or Crohn’s disease of the colon for at least 7 years and at least one-third of the colon involved participated in this cross-sectional questionnaire study performed at 3 tertiary referral inflammatory bowel disease clinics.

Results: Two hundred and eight patients were female and 189 had ulcerative colitis. The mean age was 49.9 years and mean disease duration 22.9 years. The total number of surveillance colonoscopies performed was 1529, and the mean number per patient was 4.01. The mean interval between surveillance colonoscopies was 2.71 years; 282 patients had a mean interval of <3 years. Self-reported adherence was consistently higher than chart-documented adherence. Significant categories of reasons for nonadherence were logistics (P = 0.012), health perceptions (P = 0.0001); stress regarding procedure, job, or personal life (P = 0.0002); and procedure problems (P = 0.001). The most frequently cited most important reason was difficulty with the bowel preparation (18 patients; 4.8%). Of the 26 patients with inflammatory bowel disease–related dysplasia, 3 had cancer, 4 high-grade dysplasia, 15 low-grade dysplasia, and 4 indefinite dysplasia. Detection of dysplasia was not related to adherence or to lack of adherence.

Conclusions: In this study, 25.5% of our patients underwent surveillance colonoscopies at >3-year intervals on average. Significant categories of reasons for nonadherence included logistics, health perceptions, stress, and procedure problems.

Article first published online 6 February 2013

*Division of Gastroenterology, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts

Division of Gastroenterology, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts

Section of Gastroenterology, Department of Medicine, Boston Medical Center, Boston, Massachusetts

§Department of Analysis and Information Management, University of California Los Angeles, Los Angeles, California.

Reprints: Sonia Friedman, MD, Division of Gastroenterology ASBII, Brigham and Women’s Hospital, Boston, MA 02115 (e-mail:

Supported by an unrestricted grant from Procter and Gamble.

The authors have no conflicts of interest to disclose.

Received April 16, 2012

Accepted July 03, 2012

© Crohn's & Colitis Foundation of America, Inc.
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