Clinical practice variation in the management of diminutive colorectal polyps: results of a national survey of gastroenterologists.

Abstract

We investigated physician beliefs and behaviors regarding diminutive colorectal polyps and the contribution of these beliefs to variable detection rates. One hundred sixty-seven members of the American College of Gastroenterology took a Web-based survey. We compared respondents and nonrespondents using demographic and practice information from the American Medical Association Physician Masterfile. Respondents varied in their definition of diminutive polyps. Respondents acknowledged leaving diminutive polyps in place during colonoscopy in various scenarios. Years in practice, confidence in endoscopic histologic diagnosis, and never having seen advanced histology in a diminutive polyp were predictive of leaving polyps in place. The majority of respondents were at least somewhat agreeable to leaving diminutive polyps in place if guidelines endorsed this practice. Gastroenterologists vary in their removal of diminutive polyps. The results have implications for the interpretation and management of variable polyp detection rates.