Search in the Abstract Database

Abstracts Search 2019

P237 Regional IBD surveillance endoscopy north west (RISE NoW): an audit of surveillance colonoscopy practice in inflammatory bowel disease in north-west England

Gastroenterology Trainee Research and Improvement Network North West (GasTRIN NoW)

Background

Interval surveillance colonoscopy plays a crucial role in identifying and managing colitis-related dysplasia to reduce the risk of colorectal cancer. Dye based or image enhanced chromoendoscopy have been endorsed by multiple organisations as the preferred means of detecting dysplasia since 2015. We aimed to assess the methods of surveillance utilised within the north-west of England using the established trainee research network, GasTRIN NoW.

Methods

GasTRIN NoW investigators prospectively collected data from 10 hospitals in North West England to assess surveillance practice between June and October 2018. All IBD interval surveillance colonoscopies were included. SCENIC consensus guidelines were used as the standard for adequate surveillance while BSG standards were used for the interval surveillance standard.1,2

Results

In total, 226 patients underwent IBD surveillance endoscopy (143 UC, 66 CD, 17 IBDU) with a median disease duration of 12 years (IQR 9–20). There were 122 males and the median age was 54 years (range 20–86). A total of 46 (20%) procedures did not adhere to and 21 (46%) of which were delayed (>6 months). Dye spray was used in 22%(n = 49) of the procedures while the remaining had random colonic biopsies. Image enhanced chromoendoscopy was no used in our cohort. There was more visible dysplasia identified in the dye spray cohort (13 dye spray vs. 8 non-dye spray, χ2 p = 7 × 10−6). Adenocarcinoma was confirmed in the dye spray group while no cancers were identified in the non-dye spray group. There were no differences in histological dysplasia between these groups (5 vs. 6, respectively, p = 0.11). Where withdrawal time was recorded (n = 139), median times were significantly different between both groups (dye spray 16 min (IQR: 12–25) vs. no-dye spray 10 min (8–14); χ2 p = 3.7 × 10–4).

Conclusion

Our data demonstrate that there are delays to elective IBD surveillance in clinical practice. Dye spray colonoscopy is not widely practised across north-west England. Dye spray colonoscopy identified more visible dysplasia and was associated with longer withdrawal time, a recognised surrogate marker for colonoscopy quality. Our data will inform future work in optimising IBD surveillance in England.

References

1. Laine L, Kaltenbach T, Barkun A, et al. SCENIC international consensus statement on surveillance and management of dysplasia in inflammatory bowel disease. Gastrointest Endosc 2015;81:489–501.

2. Mowat C, Cole A, Windsor A, et al. Guidelines for the management of inflammatory bowel disease in adults. Gut 2011;60:571–607.