title: Inflammatory bowel disease cancer surveillance in a tertiary referral hospital: attitudes and practice.
abstract: BACKGROUND
  Physician adherence to guidelines for colorectal cancer (CRC) surveillance in inflammatory bowel disease (IBD) is often poor. This may lead to adverse patient outcomes and excess endoscopic workload.
  
  
  OBJECTIVE
  To assess the attitudes and practice of IBD specialists in a tertiary centre towards colonoscopic surveillance.
  
  
  METHODS
  First, a questionnaire evaluating attitudes and approach to CRC surveillance was issued to 36 clinicians at one tertiary referral hospital. Second, a retrospective audit of IBD surveillance colonoscopy practice over a 2-year period was performed.
  
  
  RESULTS
  Questionnaire response rate was 97%. Sixty-nine per cent of respondents were aware of, and used, Australian guidelines. Surveillance was undertaken by all clinicians in patients with extensive colitis, 83% in patients with left-sided colitis and 51% in patients with proctitis. Seventy-six per cent used chromoendoscopy, and 47% took 10 to 20 random biopsies. Colectomy was considered appropriate in 0% for unifocal low-grade dysplasia, 35% for multifocal low-grade dysplasia and 83% for high-grade dysplasia. Sixty-six per cent would remove elevated dysplastic lesions endoscopically. The audit identified 103 surveillance colonoscopies in 81 patients. Chromoendoscopy was used in 21% of cases, and the median number of random biopsies was 13. Sixty-two per cent of colonoscopies were performed outside the guidelines in relation to colonoscopic frequency. Following colonoscopy, an appropriate recommendation for subsequent surveillance was documented in 40% of cases.
  
  
  CONCLUSIONS
  Knowledge and practice of CRC surveillance in IBD vary among specialist clinicians and often deviate from guidelines. Many clinicians perform surveillance earlier and more frequently than recommended. These findings have implications for patient outcomes and workload.
authors.affiliation: Department of Gastroenterology, St Vincent's Hospital, Melbourne, Australia; Department of Gastroenterology, Vu University Medical Centre, Amsterdam, The Netherlands.
authors.forename: E C
authors.initials: EC
authors.lastname: Verschuren
authors.forename: D E
authors.initials: DE
authors.lastname: Ong
authors.forename: M A
authors.initials: MA
authors.lastname: Kamm
authors.forename: P V
authors.initials: PV
authors.lastname: Desmond
authors.forename: M
authors.initials: M
authors.lastname: Lust
mesh_terms: D000328:Adult; D000368:Aged; D001291:Attitude of Health Personnel; D001706:Biopsy; D003082:Colectomy; D003113:Colonoscopy / Q000706:statistics & numerical data*; D015179:Colorectal Neoplasms / Q000175:diagnosis / Q000453:epidemiology / Q000517:prevention & control*; D005260:Female; D019983:Guideline Adherence; D006801:Humans; D015212:Inflammatory Bowel Diseases / Q000150:complications* / Q000601:surgery; D008297:Male; D008485:Medical Audit; D008875:Middle Aged; D011159:Population Surveillance; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D012017:Referral and Consultation; D012189:Retrospective Studies; D012307:Risk Factors; D011795:Surveys and Questionnaires; D062606:Tertiary Care Centers / Q000706:statistics & numerical data*
keywords: colitis; colorectal cancer; dysplasia; inflammatory bowel disease; surveillance