Surveillance and management of dysplasia in ulcerative colitis.
BACKGROUND
Recently updated practice guidelines give specific recommendations on surveillance and management of dysplasia in patients with ulcerative colitis. Previous studies of gastroenterologists in the United States and the United Kingdom demonstrated inconsistent surveillance techniques and limited understanding of the implications of dysplasia.


OBJECTIVE
To demonstrate current surveillance practices and management of dysplasia among U.S. gastroenterologists.


METHODS
An 18-item questionnaire was mailed to 1000 gastroenterologists in the United States who were randomly selected from an American Gastroenterological Association mailing list.


METHODS
United States.


RESULTS
A total of 334 questionnaires were returned, and 312 were analyzed: 25% of respondents were in academic practice and 75% were in private practice. The majority were in practice more than 10 years. Nearly 80% begin surveillance colonoscopy at 8 to 10 years of disease duration for patients with pancolitis, and 54% report sending at least 31 biopsy specimens. Sixty percent of respondents did not recommend immediate colectomy for a confirmed finding of low-grade dysplasia, instead opting for repeat colonoscopy in 3 to 12 months. Physicians who took fewer biopsy specimens were more likely to recommend continued surveillance for low-grade dysplasia compared with those who took a greater number of biopsy specimens.


CONCLUSIONS
Limitations included the response rate of 33% and the potential for recall bias.


CONCLUSIONS
Most U.S. gastroenterologists are practicing surveillance in patients with ulcerative colitis in accordance with published guidelines. There is widespread variation in the management of dysplasia and raised lesions, and the majority of U.S. gastroenterologists do not recommend immediate colectomy for a finding of low-grade dysplasia.
Rodriguez
Sarah A
SA
Department of Gastroenterology, Oregon Health and Science University, 3181 SW Sam Jackson Park Road, Portland, OR 97239, USA.
Collins
Judith M
JM
Knigge
Kandice L
KL
Eisen
Glenn M
GM
D001706:Biopsy / Q000379:methods / Q000706:statistics & numerical data; D002983:Clinical Competence; D003093:Colitis, Ulcerative / Q000453:epidemiology / Q000473:pathology*; D003106:Colon / Q000473:pathology*; D003113:Colonoscopy / Q000706:statistics & numerical data*; D018450:Disease Progression; D005762:Gastroenterology / Q000706:statistics & numerical data*; D006801:Humans; D009922:Oregon / Q000453:epidemiology; D010865:Pilot Projects; D015995:Prevalence; D012189:Retrospective Studies; D014861:Washington / Q000453:epidemiology