Introduction Patients with inflammatory bowel disease (IBD) have an increased risk of colorectal cancer. In 2009 the British Society of Gastroenterology updated guidelines recommending chromoendoscopy with targeted biopsies of suspicious areas, Grade A; or 2–4 biopsies every 10cm, Grade C. A local audit in Forth Valley Royal Hospital (FVRH) looking at adherence to guidelines was carried out in 2009 showing adherence to guidelines in 27% (12/44) of cases. Subsequent to this, information regarding the current guidelines was disseminated to clinicians and three medical consultants took responsibility for performing chromoendoscopy. Practice was then re-audited.
Methods FVRH is a district general hospital with a catchment area of 300,000. The endosocpy reporting tool Unisoft was used to identify patients undergoing colonoscopy with the indication “follow up - colitis surveillance” during a 1 year period from 01/01/2012. The endoscopy report was reviewed noting the endoscopist, completeness of procedure, and adherence to a surveillance guideline. The pathology reports were accessed via the SCI store computer system.
Results 87 patients were identified (44 identified over 6 months during the previous audit) as having colitis surveillance colonoscopy. 60 (69%) procedures adhered to one of the recognised surveillance strategies (37 dye-spray, 23 biopsy protocol) compared to 27% (12/44) in 2009. There has also been a marked increase in the number of patients who had chromoendoscopy; 43% (37/87) versus 4.5% (2/44) in 2009. The other main difference in this audit was the type of endoscopist performing the procedure (medical 70% v 32%, nurse 22% v 43%, surgeon 25% v 8%). Medical gastroenterologists performed 34 of the 37 chromoendoscopic procedures. Compliance rates increased in medical endoscopies to 79% (v 32%), nurses 63% (v 37%) compared to the previous audit. Dysplasia was found in 10 of the 87 cases. 8 showed low grade dysplasia in tubular adenomas, 1 was high grade dysplasia in DALM discovered using chromoendoscopy and colectomy was performed. Low grade dysplasia was also identified in one patient and they are awaiting discussion about colectomy.
Conclusion There has been a significant improvement in adherence to current guidelines after dissemination of this information to the relevant clinicians. The use of chromoendoscopy has been successfully adopted in a significant number of patients. Streamlining of procedures to endoscopists with an interest in IBD surveillance has added to the improved compliance with guidelines but there are still a number of procedures performed outwith guidelines likely in part due to the ‘generic pooling’ of endoscopy lists. The setting up of specific surveillance lists may improve compliance and chromoendoscopy rates further.
Disclosure of Interest None Declared.