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P230 ECCO endoscopy consensus for Inflammatory Bowel Disease and daily clinical practice: A need for dedicated training

L. Roque Ramos*, T. Meira, R. Barosa, P. Figueiredo, A. Vieira, J. Freitas

Hospital Garcia de Orta, Gastroenterology, Almada, Portugal

Background

Ileocolonoscopy (IC) is indispensable for the diagnosis and disease activity evaluation in Inflammatory Bowel Disease (IBD). Of note there are only two guidelines establishing minimal standards for IC in IBD [1], [2] . The primary aim was to assess the adherence of endoscopists to the ECCO's Endoscopy Consensus for IBD (ECC). The secondary endpoint was to evaluate the impact of a standard report for IBD in the endoscopy report software.

Quality parameterPhase 1 (%)Phase 2 (%)p value
Disease extension (continuous/segmental)92100ns
Ulcer size/depth5571ns
Stenosis (passable/unpassable)100100ns
Endoscopic Scoring Indexes29750,0001
Biopsies
Suspected IBD (≥ 2 in six segments)8550ns
Stenosis5680ns
Dysplasia surveillance (≥ 4 every 10 cm)5033ns
Polyp surrounding mucosa5011ns

Methods

Cross-sectional study in an Endoscopy Unit of a Central Hospital. Based on the ECC we constructed a checklist of parameters considered relevant in endoscopy reports of IBD patients, namely clinical and endoscopic data and biopsy sampling. Using the checklist a template report was produced and incorporated in the endoscopy report software; the template was also presented to the endoscopy medical team composed by 8 gastroenterologists, 3 of them specialized in IBD (Implementation Phase: May and June 2014). We reviewed the endoscopy reports produced before (Phase 1: September 2013 to April 2014) and after (Phase 2: July to October 2014) the Implementation phase and sought in each report all the checklist parameters. Phases 1 and 2 were compared using the Qui-Square or Fisher's exact tests.

Results

74 reports were evaluated: 50 in phase 1 and 24 in phase 2.

The table depicts the percentage of reports that complied with the defined quality parameters for endoscopic findings description and biopsies. On phase 1 all endoscopists stated the type of IBD, however less than 10% described the disease duration and therapy; most reports described disease extension and type of segmental involvement but size and depth of ulcers was described in <55%. Also chromoendoscopy was not used for dysplasia surveillance. In phase 2 there was a considerable increase in the use of Endoscopic Scoring Indexes (Qui-Square, p <0,05).

Conclusion

In most reports endoscopists state the type of IBD, adequately describe the disease extension and stenoses and correctly sample the mucosa when IBD is suspected. On the contrary, ulcers description and biopsies taken in the setting of dysplasia and polyps needs improvement. The simple measure of implementing a report template has a positive impact on the use of Endoscopic Scoring Indexes an increasingly important tool to monitor disease activity. Finally, the overall adherence to ECCO's endoscopy standards is not ideal and specific training on Endoscopy in IBD seems the next step to further improve the quality of endoscopy in IBD.

References:

[1] Vito Annesea, Marco Daperno, Matthew D. Rutter et al, (2013), European evidence based consensus for endoscopy in inflammatory bowel disease, Journal of Crohn's and Colitis

[2] Leighton JA, Shen B, Baron TH et al, (2006), ASGE guideline: endoscopy in the diagnosis and treatment of inflammatory bowel disease, Gastrointestinal Endoscopy