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GASTROENTEROLOGISTS’ ADHERENCE TO GUIDELINES FOR SURVEILLANCE OF DYSPLASIA IN PATIENTS WITH ULCERATIVE COLITIS AT THE HAMILTON HEALTH SCIENCES
D Kottachchi, D Yung, J Marshall
Background and AIM: The incidence of malignancy in patients with Ulcerative Colitis (UC) is increased relative to the average population. Therefore surveillance colonoscopy has been endorsed by numerous professional organizations including the Canadian Association of Gastroenterology. The aims of this study were to assess the adherence to current guidelines by gastroenterologists at the Hamilton Health Sciences (HHS), and to determine whether practice patterns have changed since the introduction of these guidelines.
METHODS: A retrospective chart review of all potential UC patients being seen between 1990 to 2006 at the HHS was performed. Patients were categorized based on their disease extent: limited left-sided (LS), pan-colonic (PC), or presence of primary sclerosing cholangitis (PSC). Appropriate timing for surveillance based on disease duration and extent, the number of biopsies undertaken at colonoscopy and the detection of dysplasia was investigated.
RESULTS: A total of 139 eligible patients with 453 surveillance endoscopy was included. Of the patients with PC disease 77% had appropriately timed surveillance. Similarly for LS disease and PSC compliance was 69% and 33%, respectively. Biopsy compliance was much poorer at 13% for patients with UC involving the entire colon, 10% for those with LS disease, and 0% for patients with PSC. After the guidelines were published, the average number of biopsies showed a statistically significant increase in all three groups. Dysplasia was discovered during colonoscopy in 24 patients, 9 of whom had appropriately timed surveillance colonoscopy after the guidelines were implemented. Two of these patients had adenocarcinoma with curative colectomy.
CONCLUSION: Overall the practice of surveillance is not sufficiently organized at the HHS. Moreover, among patients that did have a properly timed colonoscopy, the average number of biopsies taken was insufficient. However the statistically significant increase in the number of biopsies after the guidelines were published is a promising trend. Barriers still remain to improving compliance. One immediate intervention would be to establish a UC patient registry to automate, track, and inform patients who merit screening and surveillance within the Hamilton region.