Evidence

Medicare Benefits Schedule colonoscopy item restructure, 1 November 2019. Revised eight-item structure aligning surveillance colonoscopy items (32223–32226) with guideline-recommended intervals, following the MBS Review Taskforce Gastroenterology Clinical Committee. Sources: MBS Online Colonoscopy Services – FAQs (9 December 2019); MBS Explanatory Note TN.8.152.

Worthington J, He E, Lew JB, St John J, Horn C, Grogan P, Canfell K, Feletto E. Colonoscopies in Australia - how much does the National Bowel Cancer Screening Program contribute to colonoscopy use? Public Health Res Pract. 2023 Mar 15;33(1):32342216. PMID 36477980.

• MBS-funded colonoscopy rose from 284,676 (2001) to 663,213 (2019), projected to exceed 780,000 by 2030; the National Bowel Cancer Screening Program generates only 10–14%.

Bunjo Z, Koh YH, Leopardi L, Reid J, Maddern GJ, Hewett PJ. Surveillance colonoscopies frequently booked earlier than the National Health and Medical Research Council guidelines: findings of a single centre audit. ANZ J Surg. 2019 Mar;89(3):E61-E65. doi:10.1111/ans.14934. PMID 30706618.

A single-centre audit at The Queen Elizabeth Hospital, Adelaide — 467 patients on the colorectal unit surveillance waiting list. The study measures booking intervals.

• 53.7% had an incorrect surveillance colonoscopy booking.
• Of those booked incorrectly and requiring surveillance, 88.7% were too early.
• 66.1% of low-risk findings and 67.6% of history-of-CRC patients were booked incorrectly.
• Of 197 patients requiring a 5-year interval, 63.5% were booked incorrectly; 99.2% of those were early.
• More patients needing a 5-year interval were booked at 3 years (79) than at the correct 5 years (72).

Fitzsimmons T, Jayasena W, Holden CA, Dono J, Hewett P, Moore J, Sammour T. Assessing the impact of the 2018 National Health and Medical Research Council polyp surveillance guidelines on compliance with surveillance intervals at two public hospitals. ANZ J Surg. 2022;92(11):2942-2948. doi:10.1111/ans.17965. PMID 36398340.

A retrospective study at two South Australian public tertiary hospitals. Figures are from the published abstract.

• Overall compliance greater than 60%.
• Compliance fell from 65.8% under the 2011 guidelines to 50.8% under the 2018 guidelines (p<0.001, OR 0.5) — the more complex guideline reduced measured adherence.

Zammit AP, Brown I, Hooper JD, Clark DA, Riddell AD. Timing of surveillance colonoscopy following malignant colorectal polypectomy in Queensland. ANZ J Surg. 2023;93(3):606-611. doi:10.1111/ans.18069.

Queensland Oncology Repository, 2011–2019. 1,646 patients with a malignant polyp; 797 managed by polypectomy and surveillance alone.

• Median time to surveillance endoscopy was 182 days (mean 220), against a recommended 365 days.
• No patient or pathological feature predicted timing.

The abstract reports median and mean rather than a percentage booked early.

Ho YM, Merollini KMD, Collins LG. Timing Intervals and Frequency of Adenoma Surveillance Colonoscopies in Central Queensland, Australia. ANZ J Surg. 2026 Apr;96(4):935-946. doi:10.1111/ans.70517.

A retrospective study across three government hospitals in Central Queensland — 647 surveillance colonoscopies, 2018–2020.

• Early surveillance occurred in 87.5% (566 of 647).
• 93.1% of low-risk or no-adenoma patients received early surveillance; 82.6% of high-risk patients.
• Mean interval was 562 days earlier than recommended.
• No demographic or clinical factor predicted early surveillance.

Ho YM, Merollini KMD, Collins LG. Timing and Frequency of Surveillance Colonoscopies After Resection for Colorectal Cancer in Queensland, Australia: A Retrospective 10-Year Analysis. JGH Open. 2025;9(9):e70266. doi:10.1002/jgh3.70266.

7,265 patients resected for colorectal cancer.

• 82.1% had their first surveillance colonoscopy as recommended.
• Of second surveillance colonoscopies performed without polypectomy, 978 of 1,015 (96.4%) were early by at least six months; only 1.7% were on time or later.
• Early surveillance colonoscopies incurred costs of up to AU$3.78 million.

Administrative data cannot capture valid clinical reasons for early surveillance.

Ravichandran et al. Diagnostic consequence of colonoscopy repeated within 3 years at a tertiary hospital: a single-centre observational study. Intern Med J. 2026. doi:10.1111/imj.70297.

• For polyp surveillance, only 56.2% of colonoscopies were adherent to NHMRC intervals.
• Diagnostic yield for advanced adenomas, sessile serrated lesions or cancer from repeats within three years was low.

A recently published single-centre study. Figures are from the published abstract.

Ho YM, Merollini KMD, Gordon LG. Frequency of colorectal surveillance colonoscopies for adenomatous polyps: systematic review and meta-analysis. J Gastroenterol Hepatol. 2024;39(1):37-46. doi:10.1111/jgh.16397.

Australian-led systematic review providing pooled international context.

Djinbachian R, Dubé AJ, Durand M, Camara LR, Panzini B, Bouchard S, von Renteln D. Adherence to post-polypectomy surveillance guidelines: a systematic review and meta-analysis. Endoscopy. 2019;51(7):673-683. doi:10.1055/a-0865-2082. PMID 30909308.

• Overall adherence was below 50%.
• 73.6% after high-risk lesions; 24.4% after low-risk lesions.
• More than half of surveillance colonoscopies were performed too early or too late.

An international review spanning several guideline eras.

van Heijningen EMB, Lansdorp-Vogelaar I, Steyerberg EW, et al. Adherence to surveillance guidelines after removal of colorectal adenomas: a large, community-based study. Gut. 2015;64(10):1584-1592. doi:10.1136/gutjnl-2013-306453. PMID 25586057.

2,997 first-adenoma patients across 10 Dutch hospitals.

A Dutch cohort from an older guideline era.

Jorgensen ML, Young JM, Solomon MJ, et al. Patterns of follow up and survivorship care for people with colorectal cancer in New South Wales, Australia: a population-based survey. BMC Cancer. 2018;18:551. PMID 29587660.

483 participants; 379 (78%) treated with curative intent.

• Fewer than half had received guideline-recommended follow-up colonoscopy (46%, 95% CI 41–51%).
• Only 110 (23%, 95% CI 19–27%) had received a written follow-up plan.
• Socio-economic advantage predicted receipt of guideline-recommended care.

Follow-up care was patient-reported.

Wassie MM, Agaciak M, Cock C, Bampton P, Young GP, Symonds EL. The impact of coronavirus disease 2019 on surveillance colonoscopies in South Australia. JGH Open. 2021;5(4):486-492. doi:10.1002/jgh3.12525. PMID 33869788.

• Of surveillance due in 2020, 46.1% (134/291) were delayed more than 6 months, against 19.3% in 2019 (p<0.001).
• Recall-letter non-response rose specifically in patients aged 75 and over (51.6% vs 25.6%, p=0.03).

Safer Care Victoria. Albury Wodonga region colonoscopy recall — final report. October 2023.

• 1,934 impacted patients were identified and contacted; 1,750 required clinical assessment; 1,443 were referred for specialist review; 1,084 received a repeat colonoscopy; preventative treatments were provided to 548 people; 7 cancers were identified.

The trigger for this recall was procedure completeness and quality rather than surveillance-interval recall, and it concerned a single clinician. It is a system-safety case study rather than an adherence statistic.

Symonds EL, Simpson K, Coats M, Chaplin A, Saxty K, Sandford J, Young GP, Cock C, Fraser R, Bampton PA. A nurse-led model at public academic hospitals maintains high adherence to colorectal cancer surveillance guidelines. Med J Aust. 2018;208(11):492-496. doi:10.5694/mja17.00823. PMID 29902396.

SCOOP program, South Australia.

• Nurse-coordinator-led decisions matched the guidelines in 97.1% of cases (398/410); physician-led decisions in private non-academic hospitals in 83% (257/310). P<0.001.
• Compliance between individual proceduralists ranged from 32% to 93%.
• Nurse coordination increased matched decisions from 37% to 96% in the short term; adherence rose from 46% (1999) to 96% (2002) and was maintained 15 years later.
• Adherence to national guidelines could reduce annual post-polypectomy colonoscopies by 26%.

The 97.1% figure describes a structured, guideline-driven coordination model; the comparison group worked without one.

Bampton PA, Sandford JJ, Young GP. Applying evidence-based guidelines improves use of colonoscopy resources in patients with a moderate risk of colorectal neoplasia. Med J Aust. 2002;176(4):155-157. doi:10.5694/j.1326-5377.2002.tb04344.x. PMID 11913914.

Bampton PA, Sandford JJ, Young GP. Achieving long-term compliance with colonoscopic surveillance guidelines for patients at increased risk of colorectal cancer in Australia. Int J Clin Pract. 2007;61(3):510-513. doi:10.1111/j.1742-1241.2006.01158.x.

Together with the 2002 paper, documents the origin and durability of the nurse-coordinated model.

Symonds EL, Laven-Law G, Keel I, et al. A Digital Health Approach to Improve Compliance With Surveillance Colonoscopy Guidelines: The SCOPES Program: Study Protocol for a Stepped-Wedge Cluster Trial. Cancer Medicine. 2026. doi:10.1002/cam4.71456. Trial registration ACTRN12624001429549.

Natural language processing to structure colonoscopy and pathology report data, plus rule-based algorithms applying the Australian guidelines, within a nurse-coordinated digital recall model across South Australian public health networks.

This is a study protocol. The trial has no results yet.

Value In Care – optimising surveillance COLonoscopy (VIC-COL). Monash University, led by A/Prof Denise O'Connor and Prof Harriet Hiscock; funded by the HCF Research Foundation from 2022. A Victorian public-hospital collaboration involving ACSQHC, Choosing Wisely Australia, Safer Care Victoria and the Victorian Department of Health. Listed by ACSQHC as a resource supporting guideline alignment.

No published outcome evaluation located; an ongoing quality-improvement programme.

Alvarado GR, Basel AP, Hatzigeorgiou C, Fincher RK. Effect of a Polyp Tracking and Notification Program on Colon Adenoma Surveillance and Compliance to Guideline Recommendations. Mil Med. 2016;181(8):920-925. doi:10.7205/MILMED-D-15-00320. PMID 27483534.

• A surveillance registry increased the proportion offered colonoscopy in the recommended timeframe from 44% to 85%.

A single United States military institution.

Leffler DA, Neeman N, Rabb JM, et al. An alerting system improves adherence to follow-up recommendations from colonoscopy examinations. Gastroenterology. 2011;140(4):1166-1173. doi:10.1053/j.gastro.2011.01.003.

• A letter-plus-telephone recall protocol: 241/539 (44.7%) had procedures scheduled or completed versus 66/292 (22.6%) of controls (p<0.0001).

A single United States centre.

An Australian randomised controlled trial of a paper-based educational intervention in colorectal cancer patients (604 analysed; ACTRN12609000628246).

• No significant improvement in surveillance adherence: control 67/299 (27%) versus intervention 80/305 (31%); difference 4.3%, 95% CI −3.7% to 12%, p=0.296. The authors concluded the intervention was not effective.

No URL was supplied for this reference; the trial registration number is given above.

Atkin W, Wooldrage K, Brenner A, et al. Adenoma surveillance and colorectal cancer incidence: a retrospective, multicentre, cohort study. Lancet Oncol. 2017;18(6):823-834. doi:10.1016/S1470-2045(17)30187-0. PMID 28457708.

17 UK hospitals, intermediate-risk adenoma patients.

• Surveillance reduced colorectal cancer incidence in higher-risk subgroups.
• Lower-risk patients had incidence similar to the general population.

Ho YM, Merollini KMD, Collins LG. ANZ J Surg 2026 (cited above).

• Additionally found no association between early surveillance and interval cancer detection (p=0.255) or adenoma detection rate (p=0.255).
• Adenoma detection was 62.0% for early, 59.2% for appropriately timed and 56.1% for late surveillance; the lowest (49.1%) was in patients scoped without a prior adenoma.

Viiala CH, Zimmerman M, Cullen DJE, Hoffman NE. Complication rates of colonoscopy in an Australian teaching hospital environment. Intern Med J. 2003;33(8):355-359. doi:10.1046/j.1445-5994.2003.00397.x. PMID 12895166.

23,508 outpatient colonoscopies across three WA public teaching hospitals.

• Bleeding 0.21%, perforation 0.1%, procedure-attributable mortality approximately 0.01%.

An older series from public teaching hospitals; most complications were tied to therapeutic intervention.

Picardo S, et al. Adherence to endoscopic surveillance guidelines for patients with inflammatory bowel disease: An Australian cohort study. J Gastroenterol Hepatol. 2024. doi:10.1111/jgh.16438.

Western Australia. 136 patients, 263 surveillance procedures.

• 70% had their first surveillance within an appropriate interval; 37% of patients had complete adherence.
• Chromoendoscopy or advanced imaging in 16%.

Elford AT, Hirsch R, McKay OM, Browne M, Moore GT, Bell S, Swan M. Identifying the real-world challenges of dysplasia surveillance in inflammatory bowel disease: a retrospective cohort study in a tertiary health network. Intern Med J. 2024 Jan;54(1):96-103. doi:10.1111/imj.16102. PMID 37093665.

Victorian tertiary network. 115 dysplasia surveillance colonoscopies.

• 37% of index dysplasia colonoscopies were outside recommended guidelines.
• 28% underwent dye-based chromoendoscopy; 69% high-definition white-light endoscopy.
• 10% had inadequate bowel preparation; only 40% excellent.
• Dysplasia or colorectal cancer detected in 3.4%.

Cancer Council Australia Colonoscopy Surveillance Working Party. Clinical Practice Guidelines for Surveillance Colonoscopy. Sydney: Cancer Council Australia.

https://www.cancer.org.au/health-professionals/clinical-practice-guidelines/surveillance-colonoscopy

The guideline version and date Polly’s rule engine is built against will be stated here once confirmed.