title: Surveillance for dysplasia in patients with ulcerative colitis: Discrepancy between guidelines and practice.
abstract: OBJECTIVE
  The risk of developing colorectal cancer is higher in patients with ulcerative colitis (UC) than in the general population. Guidelines recommend surveillance colonoscopy (SCS) to reduce mortality; however, few studies have assessed physicians' adherence to guidelines. This study was aimed to clarify the current status of SCS and adherence to guidelines through the characteristics of cancer/dysplasia surveillance for UC patients in Japan.
  
  
  METHODS
  A questionnaire was mailed to 541 physicians who attended meetings on inflammatory bowel disease.
  
  
  RESULTS
  The respondents encountered a median of 100 UC cases. Thirty percent of the respondents had never managed a UC patient with cancer. Fifty-one percent of the respondents had never diagnosed colorectal cancer with UC. Forty-seven percent of the respondents considered extensive colitis and left-sided colitis as indications for SCS, and 38% carried out SCS regardless of the disease extent. Sixty-three percent of the respondents started SCS at 7-10 years after UC onset, whereas 20% started SCS at 3 years or less. Fifty-two percent of the respondents obtained targeted biopsies only, and chromoendoscopy was used by 49% of the respondents as a special technique for surveillance. Median number of biopsies at SCS was five per patient; it was three among patients whose biopsy was carried out by physicians who obtained targeted biopsies only and seven among those carried out by physicians who obtained step biopsies and targeted biopsies (P < 0.0001).
  
  
  CONCLUSIONS
  A considerable proportion of the respondents did not follow the guidelines when selecting patients for surveillance and carrying out SCS.
authors.affiliation: Department of Surgery, the Institute of Medical Science, the University of Tokyo, Tokoyo, Japan.
authors.forename: Masaru
authors.initials: M
authors.lastname: Shinozaki
authors.affiliation: Research and Development Center for New Medical Frontiers, School of Medicine, Kitasato University, Sagamihara, Japan.
authors.forename: Kiyonori
authors.initials: K
authors.lastname: Kobayashi
authors.affiliation: Inflammatory Bowel Disease Center, Yokohama City University Medical Center, Yokohama, Japan.
authors.forename: Reiko
authors.initials: R
authors.lastname: Kunisaki
authors.affiliation: The Third Department of Internal Medicine, Kyorin University School of Medicine, Tokyo, Japan.
authors.forename: Tadakazu
authors.initials: T
authors.lastname: Hisamatsu
authors.affiliation: Division of Gastroenterology and Hepatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan.
authors.forename: Makoto
authors.initials: M
authors.lastname: Naganuma
authors.affiliation: Coloproctology Center, Tohoku Rosai Hospital, Sendai, Japan.
authors.forename: Ken-Ichi
authors.initials: KI
authors.lastname: Takahashi
authors.affiliation: Center for Preventive Medicine, Keio University Hospital, Tokyo, Japan.
authors.forename: Yasushi
authors.initials: Y
authors.lastname: Iwao
authors.affiliation: Department of Internal Medicine, Toho University Sakura Medical Center, Sakura, Japan.
authors.forename: Yasuo
authors.initials: Y
authors.lastname: Suzuki
authors.affiliation: Department of Gastroenterology and Hepatology, Tokyo Medical and Dental University, Tokyo, Japan.
authors.forename: Mamoru
authors.initials: M
authors.lastname: Watanabe
authors.affiliation: Department of Surgery, Institute of Gastroenterology, Tokyo Women's Medical University, Tokyo, Japan.
authors.forename: Michio
authors.initials: M
authors.lastname: Itabashi
authors.affiliation: Torii Clinic, Tokyo, Japan.
authors.forename: Akira
authors.initials: A
authors.lastname: Torii
authors.affiliation: Division of Gastroenterology, Department of Medicine, Tokyo Yamate Medical Center, Tokyo, Japan.
authors.forename: Masakazu
authors.initials: M
authors.lastname: Takazoe
authors.affiliation: Inflammatory Bowel Disease Center, Yokohama Municipal Hospital, Yokohama, Japan.
authors.forename: Akira
authors.initials: A
authors.lastname: Sugita
mesh_terms: D003093:Colitis, Ulcerative / Q000473:pathology*; D003110:Colonic Neoplasms / Q000175:diagnosis*; D003113:Colonoscopy; D005260:Female; D019983:Guideline Adherence; D006801:Humans; D007564:Japan; D008297:Male; D018579:Patient Selection; D010818:Practice Patterns, Physicians'
keywords: colonoscopy; dysplasia; questionnaire; surveillance; ulcerative colitis