DOP081 Outcomes of colitis-associated dysplasia after referral from the community to a tertiary centre
D. Rubin*, N. Krugliak Cleveland, D. Rodriquez
University of Chicago Medicine, Inflammatory Bowel Disease Centre, Chicago, Illinois, United States
The SCENIC consensus statement recommends that when dysplasia is found by a less experienced endoscopist using white light, referral to an expert endoscopist for high-definition (HD) colonoscopy with chromoendoscopy should occur, but the evidence for such a recommendation was noted to be of very low quality (Laine,et al. Gastroenterol 2015). We assessed our ‘real-world’ experience with a variant of this type of referral practice.
We used our IBD database to identify UC patients (pts) referred from community gastroenterologists for a diagnosis of dysplasia to our tertiary IBD centre for further assessment between 2008 and 2015. All pts included had confirmation of their dysplasia diagnosis by our expert GI pathologists and were then scoped by an expert endoscopist (DTR) with >10 years of chromoendoscopy experience. The decision between HD with NBI or HD with methylene blue (MB) chromoendoscopy was made based on equipment and pt presentation. We reviewed risk factors for dysplasia, the type of procedure, the endoscopic and histologic findings, and whether the index lesions were identified, as well as any additional lesions that were found. With the exception of the rectum, lesions found within one segment of the index location were considered the same lesion. Upgrading or downgrading of lesions was also assessed.
In total, 53 patients were referred for further evaluation of 85 index lesions (71 low-grade dysplasia [LGD]; 7 high-grade dysplasia [HGD]; 5 indefinite; 1 cancer [CA]; and 3 sessile serrated lesions) that had been found on the 53 outside white light colonoscopies. At our centre, 37 subsequent exams were performed with HD colonoscopy with MB chromoscopy, and the remaining exams were performed by HD white light with or without narrow band imaging (NBI). More of the index lesions were found using HD/MB (42% of 62 lesions) than using HD/NBI (17% of 23 lesions). HD/MB exams also identified more additional neoplastic lesions per exam (12 lesions/37 exams, 0.32 additional lesion/exam, including 2 CA and 1 HGD) than did the HD/NBI exams (3 lesions/16 exams, 0.19 additional lesion/exam, all LGD).
This real-world analysis of patients referred to a tertiary expert IBD endoscopist for assessment of dysplasia shows an important yield of additional lesions. Pts who had HD scopes with MB chromoendoscopy were more likely to have their index reidentified and more likely to have identified additional advanced lesions of clinical significance. This series supports the evaluation of pts who have LGD found by white light exam by an expert endoscopist, and favours the use of HD with chromoendoscopy.