ECCO Topical Review Optimising Reporting in Surgery, Endoscopy, and Histopathology

Abstract

Background and Aims Diagnosis and management of inflammatory bowel diseases (IBD) requires a lifelong multidisciplinary approach. The quality of medical reporting is essential in this context. The present topical review addresses the need for optimised reporting in endoscopy, surgery, and histopathology. Methods A consensus expert panel consisting of gastroenterologists, surgeons, and pathologists convened by the European Crohn’s and Colitis Organisation performed a systematic literature review. Following topics were covered: In endoscopy: (i) general IBD endoscopy; (ii) disease activity and surveillance; (iii) endoscopy treatment in IBD. In surgery: (iv) medical history with surgical relevance, surgical indication and strategy; (v) operative approach; (vi) intraoperative disease description; (vii) operative steps. In pathology: (viii) macroscopic assessment and interpretation of resection specimens; (ix) IBD histology, including biopsies, surgical resections, and neoplasia; (x) IBD histology conclusion and report. Statements were developed using a Delphi methodology incorporating two consecutive rounds. Current practice positions were set when >80% of participants agreed on a recommendation. Results Thirty practice positions established a standard terminology for optimal reporting in endoscopy, surgery, and histopathology. Assessment of disease activity, surveillance recommendations, advice to surgeons for operative indication and strategies, including margins and extent of resection, and diagnostic criteria of IBD, as well as guidance for the interpretation of dysplasia and cancer were handled. A standardized report including a core set of items to include in each speciality report, was defined. Conclusions Interdisciplinary high-quality care requires thorough and standardised reporting across specialities. This topical review offers an actionable framework and practice recommendations to optimise reporting in endoscopy, surgery, and histopathology.

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“…A minimum of two biopsies from at least five sites along the colon, including the rectum and the terminal ileum, should be obtained. 22 The features that most strongly support a diagnosis of IBD in a biopsy are basal plasmacytosis and architectural changes. Histological distinction between UC and CD in clinical practice may be difficult.…”

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“…22 Diagnostic features of CD are a discontinuous or focal chronic inflammation with focal crypt irregularity and granulomas. 22…”