Today’s Annals of Internal Medicine reports a study suggesting that colonoscopies may be overdone. This story was picked up by the lay press.

With regards to hyperplastic polyps, the guidelines are unclear. Here is what UptoDate says:

At the present time, there is no clear consensus regarding what recommendations should be given to asymptomatic patients at average risk for CRC who are found to have a distal hyperplastic polyp on a screening sigmoidoscopy. Thus, decisions should be individualized after informing the patient of the uncertainty versus the risks and benefits of a colonoscopy.

The article provides more clarity and comes up with this recommendation:

Clinical practice guidelines for adenoma surveillance typically recommend colonoscopy at 3 years after finding a large adenoma and at 3 to 5 years after detection of a small adenoma; surveillance is not recommended for a hyperplastic polyp.

With these guidelines in mind, here are the results of the survey:

Among gastroenterologists (317 of 349) and surgeons (125 of 316) who perform screening colonoscopy, 24% (95% CI, 19.3% to 28.7%) of gastroenterologists and 54% (CI, 44.9% to 62.5%) of surgeons recommend surveillance for a hyperplastic polyp. For a small adenoma, most physicians recommended surveillance colonoscopy and more than 50% recommended examinations every 3 years or more often.

These findings suggest that colonoscopies are overused, contributing to the worsening wait-times for this procedure as well as increasing health-care costs.

However, do guidelines really matter in real-world medicine? They don’t even stand up in court. Remember, physicians are sued for doing too little and missing the “one that got away”, and never for doing too much. Until defensive medicine is reigned in and punished, it’s unlikely that this colonoscopy trend would change.