Are IBD patients getting appropriate surveillance colonoscopies?
Hussain KM, Watt L, Hillemand C, Murphy SJ
Department of Medicine & Gastroenterology, Daisy Hill Hospital, Newry, Co. Down, Southern Health and Social Care Trust
2002 BSG and 2011 NICE guideline recommend offering colonoscopic surveillance to people with inflammatory bowel disease (IBD) whose symptoms started 10 years ago and who have ulcerative colitis or Crohn's colitis. Further surveillance colonoscopies are suggested at intervals based on risk stratification i.e. low, intermediate and high risk. Pancolonic dye spray with targeted or 2-4 random biopsies every 10cm should be taken.
To compare our current practice of surveillance colonoscopies of IBD patients with BSG and NICE guidance.
50 consecutive IBD patients were identified from Unisoft Endoscopy Reports who had an IBD surveillance colonoscopy performed in the Southern Trust during the time period February 2014 to December 2014. Data collection involved reviewing clinical notes and histology reports from electronic care record and colonoscopy reports from Unisoft.
Out of 50 patients, 56% were male. 82 % were over 40 years of age and 82% had a diagnosis of UC whereas only 18% had Crohn’s colitis. Repeat surveillance colonoscopies being booked by clinician/endoscopist were appropriate in 60% of cases (30/50). In just above one third (17/50) of cases booking details were not available on previous colonoscopy report or electronic care record. Only 3 out of 50 patients had surveillance colonoscopy done earlier than due time (2 cases 1 year and 1 case 3 years early). Half (25/50) of patients had surveillance colonoscopy performed at the correct time interval whereas just below half of patients (24/50) had delays ranging from 1-18 years with average delay of 3.2 years. Only one out of 50 had colonoscopy performed earlier than required (9 years) .No patient had chromoendoscopy performed and only one patient had >30 biopsies taken. Only 44% (22/50) of patients had minimum required number (16-29) of biopsies taken whereas less than 16 biopsies were taken in 50% of patients (25/50) and 2 patients did not have any biopsies taken.
Our current practice is far from meeting the criteria set by NICE and BSG. Clinicians and endoscopists need awareness of current guidelines for colonoscopy surveillance. More research regarding low uptake of chromoendoscopy among endoscopists is required.