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P171. Translation from guidelines to practice, use of endoscopy for initial diagnosis of IBD [on behalf of Dutch Delta IBD group]

V. Nuij1, R. Ouwendijk2, H. Smalbraak3, K. Bruin4, R. Beukers5, E. Kuipers6, C.J. van der Woude1

1Erasmus Medical Center, Department of Gastroenterology & Hepatology, Rotterdam, Netherlands; 2Ikazia Ziekenhuis, Department of Gastroenterology & Hepatology, Rotterdam, Netherlands; 3Lievensberg Ziekenhuis, Department of Internal Medicine, Bergen op Zoom, Netherlands; 4Tweesteden Ziekenhuis, Department of Gastroenterology & Hepatology, Tilburg, Netherlands; 5Albert Schweitzer Ziekenhuis, Department of Gastroenterology & Hepatology, Dordrecht, Netherlands; 6Erasmus Medical Center, Rotterdam, Netherlands

Background: Current ECCO guidelines state, that in case of suspected IBD, an ileocolonoscopy is the first line procedure to establish the diagnosis. Our aim was to assess whether this advice is followed in clinical practice and to determine the influence of endoscopy on treatment strategies during follow-up.

Methods: In patients (pts) diagnosed with IBD in 2006, in eight non-academic hospitals in the south-west of the Netherlands, all endoscopies performed between diagnosis and January 1st, 2010 were evaluated.

Results: In total 390 pts were diagnosed with IBD in these hospitals (47% CD, 47% UC, 6% IBDU). Mean time of follow-up was 33 months (range 0.2–47.9). Overall 771 endoscopies were performed (median of 2 per pts, range 0–9); 256 ileocolonoscopies, 211 colonoscopies, 242 lower endoscopies and 62 upper endoscopies. Endoscopy led to the diagnosis in 346 pts (42% UC, 52% CD, 6% IBDU), other resources which contributed to the diagnosis were surgery (3%), radiology (13%), or pathology (14%). Only 113 pts (29%) underwent an ileocolonoscopy at diagnosis. Of the 276 patients not receiving an ileocolonoscopy at diagnosis, 80 did in follow-up. CD pts underwent significantly more ileocolonscopies at diagnosis, compared to UC pts (44% vs 17%, p < 0.001) and IBDU pts (44% vs 4.5%, p = 0.001). Reasons for follow-up endoscopy were: relapse of symptoms (76%), evaluating treatment effect and/or disease extension (22%) and cancer surveillance (2.4%). In 71% of the follow-up endoscopies active inflammation was seen, however this led to treatment intensification in only 65%.

Conclusions: Endoscopies is an often used tool in IBD patients, although only 29% patients received an ileocolonoscopy at diagnosis. Fourty-five percent of the endoscopies performed at follow-up led to treatment intensification, but in over one third of endoscopies showing inflammation, no adjustments were made.