Adherence to post-polypectomy surveillance guidelines: a systematic review and meta-analysis.

BACKGROUND: Colorectal cancer (CRC) is a major worldwide cause of cancer-related mortality. Colonoscopy programs based on guideline-recommended surveillance intervals have been put in place to reduce the morbidity and mortality associated with CRC. We were interested to evaluate clinical practice adherence to guideline-recommended surveillance intervals, the potential extent of early repeat colonoscopies, and causes of nonadherence to guideline recommendations. METHODS: We performed a literature search for articles reporting on guideline adherence for surveillance colonoscopies. Exclusion criteria included inflammatory bowel disease and hereditary CRC syndrome cohorts. Primary outcome was correct interval assignment in patients undergoing surveillance colonoscopy. Groups were assessed for adherence according to their respective guideline recommendations (North American or European). RESULTS: 16 studies were included in the analysis. The mean colonoscopy surveillance interval adherence rate was 48.8 % (95 % confidence interval [CI] 37.3 - 60.4). For North American guidelines, surveillance interval assignments were adherent to guideline recommendations in 44.7 % (95 %CI 24.2 - 66.3) of patients after detection of low risk lesions and in 54.6 % (95 %CI 41.4 - 67.4) after detection of high risk lesions. For European guidelines, surveillance interval assignments were adherent to recommendations in 24.4 % (95 %CI 1.1 - 63.4) of patients after detection of low risk lesions and in 73.6 % (95 %CI 35.5 - 98.8) after detection of high risk lesions. CONCLUSIONS: The worldwide adherence to surveillance colonoscopy guidelines was low, with more than 50 % of patients undergoing repeat colonoscopies either too early or too late. Early repeat colonoscopies occurred with the highest frequency for patients in whom only hyperplastic polyps or low risk adenomas were found.

Associations between Maternal Exposure to Bisphenol A or Triclosan and Gestational Hypertension and Preeclampsia: The MIREC Study.

BACKGROUND: Little is known about the association between bisphenol A (BPA) or triclosan (TCS) exposure and hypertension in pregnancy. OBJECTIVE: To investigate potential associations between maternal urinary concentrations of BPA or TCS and gestational hypertension (GH) and preeclampsia. STUDY DESIGN: Among 1,909 pregnant women participating in the maternal-infant research on environmental chemicals (MIREC) study, urinary concentrations of BPA and TCS were measured in the first trimester by liquid chromatography-tandem mass spectrometry using isotope dilution. Blood pressure was measured during each trimester. Multinomial regression was performed to estimate the adjusted odds ratio (aOR) and 95% confidence intervals (CI) for the associations between these phenols and GH and preeclampsia. RESULTS: BPA and TCS were not associated with GH or preeclampsia. However, in multiparous women, BPA (0.50-1.30 µg/L) was associated with decreased risk of GH (aOR =0.45; 95%CI: 0.21-0.98) while among nulliparous women, TCS was associated with an increased risk of GH (3.60-32.60 µg/L; aOR = 2.58; 95% CI: 1.09-6.13 and > 32.60 µg/L: aOR = 2.74; 95% CI: 1.15-6.51). CONCLUSION: BPA and TCS urinary concentrations were not associated with GH or preeclampsia; however, our results suggest an association between TCS and GH in nulliparous women. Additional studies are required to confirm our results.