How gastroenterologists screen for colonic cancer in ulcerative colitis: an analysis of performance.
BACKGROUND
The aim of this study was to assess the colorectal cancer surveillance practices of British gastroenterologists for patients with ulcerative colitis.


METHODS
A questionnaire that investigated aspects of surveillance in patients with ulcerative colitis was mailed to all consultant gastroenterologists in the U.K. (n = 413).


RESULTS
Three hundred forty-one questionnaires were returned (response rate 83%). Ninety-four percent of consultants practice cancer surveillance in ulcerative colitis, with 35% maintaining a registry of patients in surveillance programs. All gastroenterologists perform surveillance in patients with pancolitis, 24% in those with left-sided colitis and 2% in patients with proctitis. The mean duration of disease before surveillance is commenced is 9.2 years for pancolitis and 12.4 years for left-sided colitis (p < 0.0001). Only 4% of gastroenterologists routinely offer patients with disease of more than 10 years' duration a prophylactic colectomy. Colonoscopies are conducted by an accredited gastroenterologist in 65% of cases and biopsies are reviewed by specialists in gastrointestinal pathology in 45%. When histology reveals low-grade dysplasia only 4% advise colectomy and when high-grade dysplasia is found 53% recommend colectomy. Sixteen percent of gastroenterologists were unaware of the significance of a dysplasia associated lesion or mass.


CONCLUSIONS
The majority of gastroenterologists practice surveillance on a disorganized basis. There is inconsistency in the management of patients with dysplasia and education of gastroenterologists is needed.
Eaden
J A
JA
Gastrointestinal Research Unit, Leicester General Hospital, Leicester, UK.
Ward
B A
BA
Mayberry
J F
JF
D001706:Biopsy; D003093:Colitis, Ulcerative / Q000150:complications* / Q000473:pathology; D003106:Colon / Q000473:pathology; D003113:Colonoscopy; D015179:Colorectal Neoplasms / Q000175:diagnosis / Q000209:etiology / Q000517:prevention & control*; D005762:Gastroenterology / Q000706:statistics & numerical data*; D006767:Hospitals, District; D006784:Hospitals, Teaching; D006801:Humans; D010818:Practice Patterns, Physicians'; D012307:Risk Factors; D011795:Surveys and Questionnaires; D013997:Time Factors; D006113:United Kingdom