Adherence to surveillance guidelines for dysplasia and colorectal carcinoma in ulcerative and Crohn's colitis patients in the Netherlands.
OBJECTIVE
To study adherence to the widely accepted surveillance guidelines for patients with long-standing colitis in The Netherlands.


METHODS
A questionnaire was sent to all 244 gastroenterologists in The Netherlands.


RESULTS
The response rate was 63%. Of all gastroenterologists, 95% performed endoscopic surveillance in ulcerative colitis (UC) patients and 65% in patients with Crohn's colitis. The American Gastroenterological Association (AGA) guidelines were followed by 27%, while 27% and 46% followed their local hospital protocol or no specific protocol, respectively. The surveillance was correctly initiated in cases of pancolitis by 53%, and in cases of left-sided colitis by 44% of the gastroenterologists. Although guidelines recommend 4 biopsies every 10 cm, less than 30 biopsies per colonoscopy were taken by 73% of the responders. Only 31%, 68% and 58% of the gastroenterologists referred patients for colectomy when low-grade dysplasia, high-grade dysplasia (HGD) or Dysplasia Associated Lesion or Mass (DALM) was present, respectively.


CONCLUSIONS
Most Dutch gastroenterologists perform endoscopic surveillance without following international recommended guidelines. This practice potentially leads to a decreased sensitivity for dysplasia, rendering screening for colorectal cancer in this population highly ineffective.
van Rijn
Anne F
AF
Department of Gastroenterology and Hepatology, Academic Medical Center, University of Amsterdam, Amsterdam 1105AZ, The Netherlands.
Fockens
Paul
P
Siersema
Peter D
PD
Oldenburg
Bas
B
D001706:Biopsy; D003093:Colitis, Ulcerative / Q000150:complications* / Q000473:pathology; D015179:Colorectal Neoplasms / Q000175:diagnosis* / Q000209:etiology*; D003424:Crohn Disease / Q000150:complications* / Q000473:pathology; D016099:Endoscopy, Gastrointestinal; D005762:Gastroenterology / Q000592:standards; D006801:Humans; D009426:Netherlands; D017410:Practice Guidelines as Topic; D011795:Surveys and Questionnaires; D013997:Time Factors