Perception of Cancer Risk and Management Practice for Colitis-associated Dysplasia Is Influenced by Colonoscopy Experience and Workplace Affiliation: Results of an International Clinician Survey

• Published in: Journal of Crohn's and colitis Vol. 16; no. 1; pp. 39 - 48
• Main Authors: Kabir, Misha, Thomas-Gibson, Siwan, Hart, Ailsa L, Wilson, Ana
• Format: Journal Article
• Language: English
• Published: UK Oxford University Press 28.01.2022
• Subjects: Colectomy; Colitis, Ulcerative - pathology; Colitis, Ulcerative - surgery; Colonoscopy; Colorectal Neoplasms - pathology; Colorectal Neoplasms - surgery; Cross-Sectional Studies; Gastroenterologists; Health Knowledge, Attitudes, Practice; Humans; Hyperplasia - pathology; Internationality; Original; Practice Patterns, Physicians' - statistics & numerical data; Precancerous Conditions - pathology; Precancerous Conditions - surgery; Risk Assessment; Surveys and Questionnaires; Dysplasia; colorectal cancer; surveillance
• ISSN: 1873-9946; 1876-4479
• DOI: 10.1093/ecco-jcc/jjab110

Abstract Background and Aims A successful colitis cancer surveillance programme requires effective action to be taken when dysplasia is detected. This is the first international cross-sectional study to evaluate clinician understanding of dysplasia-cancer risk and management practice since the most recent international guidelines were introduced in 2015. Methods A 15-item international online survey was disseminated to gastroenterologists and colorectal surgeons. Results A total of 294 clinicians [93.5% gastroenterologists] from 60 countries responded; 23% did not have access to high-definition chromoendoscopy. University hospitals were more likely than non-academic workplaces to provide second expert histopathologist review [67% vs 46%; p = 0.002] and formal multidisciplinary team meeting discussion [73% vs 52%; p = 0.001] of dysplasia cases. Perceptions of 5-year cancer risk associated with endoscopically unresectable low-grade dysplasia varied between 0% and 100%. Non-academic hospital affiliation was predictive of lower perceived cancer risks. Although most [98.4%] respondents advised a colectomy for endoscopically unresectable visible high-grade dysplasia, only 34.4% advised a colectomy for unresectable visible low-grade dysplasia. Respondents from university hospitals were more likely to consider colectomy for multifocal low-grade dysplasia (odds ratio [OR] 2.17). If invisible unifocal low-grade dysplasia was detected, continued surveillance over colectomy was the preferred management among clinicians working mainly in private clinics [OR 9.4] and least preferred in those who had performed more than 50 surveillance colonoscopies [OR 0.41]. Conclusions Clinicians with less surveillance colonoscopy experience and from non-academic centres appear to have lower cancer risk perceptions and are less likely to advocate colectomy for higher-risk low-grade dysplasia. Further education may align current management practice with clinical guidelines. Graphical Abstract