Evaluation of French guidelines on the indications of colonoscopy: results of a regional practice survey.

BACKGROUND AND AIMS: Compliance with guidelines on colonoscopic indications can improve colorectal cancer screening efficiency. We conducted a regional practice survey of gastroenterologists working in the public and private sectors in France, and compared the results with French national guidelines. METHODS: Four consecutive yearly questionnaire-based practice surveys were conducted, and remedial measures were recommended on the basis of the results. RESULTS: We analyzed 5128 colonoscopies carried out by 65 practitioners. Of these, 4266 (83.2%) conformed to contemporary guidelines, 391 (7.6%) did not conform, and 471 (9.2%) could not be classified, owing to a lack of information. Remedial measures led to a significant increase in the number of colonoscopies conforming to guidelines (p=0.037) and to a significant fall in the number of unclassified procedures (p=0.0018). The distribution of colonic lesions differed between procedures that did and did not conform to guidelines (2.4% versus 0.3% of colorectal cancers, 11.4% vs. 6.9% of advanced adenomas, and 17.5% vs. 14.6% of non-advanced adenomas; p<0.0001). CONCLUSION: This longitudinal multicenter survey shows that national colonoscopy guidelines are largely respected in France and improve the detection of colonic neoplasia. Practices improved following implementation of remedial measures.