Surveillance for Dysplasia in Patients With Inflammatory Bowel Disease: A National Survey of Colonoscopic Practice in New Zealand

Gearry, Richard B.; Wakeman, Christopher; Barclay, Murray L.; Chapman, B. A.; Collett, Judith A.; Burt, Michael; Frizelle, Frank

doi:10.1007/s10350-003-0049-y

Cited by 42 publications

(48 citation statements)

References 38 publications

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“…Our finding was consistent with prior studies of varied compliance with practice guidelines, in particular the low use of surveillance colonoscopy (25%) for patients with longstanding UC in an integrated healthcare delivery system in the USA [18,19,20,21,22]. IBD patients in our study sample presumably had CRC associated with longstanding colitis, although the retrospective nature of our study precluded detailed information on the duration, extent and severity of colitis.…”

Section: Discussionsupporting

confidence: 81%

“…Adherence to surveillance colonoscopy guidelines for patients with ulcerative colitis (UC) has varied in clinical practice. Surveys of gastroenterologists showed that most gastroenterologists performed some form of surveillance for UC patients [18,19,20]. However, one survey suggested that only about half of IBD specialists and community gastroenterologists would recommend surveillance colonoscopy for a hypothetical patient with left-sided colitis [21].…”

Section: Introductionmentioning

confidence: 99%

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Use of Surveillance Colonoscopy in Medicare Patients with Inflammatory Bowel Disease prior to Colorectal Cancer Diagnosis

et al. 2014

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Background: Patients with longstanding inflammatory bowel disease (IBD) involving large intestine proximal to rectum are considered to be at increased risk for colorectal cancer (CRC). One prior study showed low utilization of surveillance colonoscopy in patients with ≥8 years of ulcerative colitis (UC) in the USA. Aims: To study use of surveillance colonoscopy among Medicare beneficiaries with IBD in the 2-year period prior to CRC diagnosis. Data and Methods: Our study sample included Medicare beneficiaries in the SEER-Medicare-linked database who were diagnosed with CRC during 2001-2005 and had ≥3 physician visits with ICD-9 diagnosis code for IBD prior to CRC diagnosis. Medicare beneficiaries aged >85 years without Part B coverage or enrolled in HMOs were excluded. Colonoscopy performed within 6-30 months prior to CRC diagnosis was defined as surveillance colonoscopy. The χ² test and multivariate logistic regression were used in statistical analysis. Results: Of 241 Medicare beneficiaries with IBD and diagnosed with CRC, 92 (38%) patients underwent ≥1 surveillance colonoscopy in the 2 years prior to cancer diagnosis. The use of surveillance colonoscopy was similar between Crohn's disease (28/86, 33%) and UC (64/155, 41%). In multivariate logistic regression, older age (odds ratio (OR) 0.97, 95% confidence interval (CI) 0.94-0.99) was negative associated with surveillance colonoscopy use and personal history of colon polyp (OR 2.73, 95% CI 1.09-6.87) was positively associated with surveillance colonoscopy use. Conclusions: Use of surveillance colonoscopy was low among Medicare beneficiaries with IBD in the 2 years prior to CRC diagnosis.

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Section: Discussionsupporting

confidence: 81%

Section: Introductionmentioning

confidence: 99%

Use of Surveillance Colonoscopy in Medicare Patients with Inflammatory Bowel Disease prior to Colorectal Cancer Diagnosis

et al. 2014

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“…This number of biopsies was estimated to be necessary to detect possible dysplasia with a sensitivity of 90% [10] . A similar questionnaire-based study in New Zealand showed a median number of 17 biopsies [12] . This again, will inevitably lead to a pronounced decrease in sensitivity, rendering the surveillance tool ineffective.…”

Section: Discussionmentioning

confidence: 75%

“…Even the presence of LGD, which is associated with CRC in 21.4%-54%, can be considered an indication for surgery [4,6] . There is a disconcertingly low referral rate for colectomy amongst Dutch GEs, and even more so when findings are compared with 3 similar questionnaire-based studies in New Zealand, United Kingdom and Canada [12][13][14] . It is remarkable that the referral rate is higher for LGD and much lower for HGD and DALM compared with the other studies.…”

Section: Discussionmentioning

confidence: 99%

Adherence to surveillance guidelines for dysplasia and colorectal carcinoma in ulcerative and Crohn’s colitis patients in the Netherlands

Rijn

Fockens²,

Siersema³

et al. 2009

WJG

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AIM:To study adherence to the widely accepted surveillance guidelines for patients with long-standing colitis in the Netherlands. METHODS:A questionnaire was sent to all 244 gastroenterologists in the Netherlands. RESULTS:The response rate was 63%. Of all gastroenterologists, 95% performed endoscopic surveillance in ulcerative colitis (UC) patients and 65% in patients with Crohn's colitis. The American Gastroenterological Association (AGA) guidelines were followed by 27%, while 27% and 46% followed their local hospital protocol or no specific protocol, respectively. The surveillance was correctly initiated in cases of pancolitis by 53%, and in cases of left-sided colitis by 44% of the gastroenterologists. Although guidelines recommend 4 biopsies every 10 cm, less than 30 biopsies per colonoscopy were taken by 73% of the responders. Only 31%, 68% and 58% of the gastroenterologists referred patients for colectomy when low-grade dysplasia, high-grade dysplasia (HGD) or Dysplasia Associated Lesion or Mass (DALM) was present, respectively. CONCLUSION:

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“…A more recent study of both colorectal surgeons and gastroenterologists from New Zealand similarly found poor knowledge of the definition of dysplasia, with only 20% responding correctly. In this group, the colorectal surgeons defined dysplasia correctly more often and understood the significance of low grade dysplasia as well (Geary et al, 2004). Despite clear recommendations from the American Gastroenterological Association to perform four quadrant biopsies every ten cm for a total of thirty to forty biopsies, only 41% of gastroenterologists followed this recommendation.…”

Section: Hurdles To Successful Screening Surveillance Programmentioning

confidence: 99%

Colorectal Cancer in Ulcerative Colitis Patients

Feuerstein¹,

Wasan²

2012

Ulcerative Colitis From Genetics to Complications

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Surveillance for Dysplasia in Patients With Inflammatory Bowel Disease: A National Survey of Colonoscopic Practice in New Zealand

Cited by 42 publications

References 38 publications

Use of Surveillance Colonoscopy in Medicare Patients with Inflammatory Bowel Disease prior to Colorectal Cancer Diagnosis

Use of Surveillance Colonoscopy in Medicare Patients with Inflammatory Bowel Disease prior to Colorectal Cancer Diagnosis

Adherence to surveillance guidelines for dysplasia and colorectal carcinoma in ulcerative and Crohn’s colitis patients in the Netherlands

Colorectal Cancer in Ulcerative Colitis Patients

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