Brief Articles
Copyright ©2009 The WJG Press and Baishideng. All rights reserved.
World J Gastroenterol. Jan 14, 2009; 15(2): 226-230
Published online Jan 14, 2009. doi: 10.3748/wjg.15.226
Adherence to surveillance guidelines for dysplasia and colorectal carcinoma in ulcerative and Crohn’s colitis patients in the Netherlands
Anne F van Rijn, Paul Fockens, Peter D Siersema, Bas Oldenburg
Anne F van Rijn, Paul Fockens, Department of Gastroenterology and Hepatology, Academic Medical Center, University of Amsterdam, Amsterdam 1105AZ, The Netherlands
Peter D Siersema, Bas Oldenburg, Department of Gastroenterology and Hepatology, University Medical Centre Utrecht, Utrecht 3584CX, The Netherlands
Author contributions: Oldenburg B and van Rijn AF designed the study and wrote the paper; Data were collected and analyzed by van Rijn AF; Fockens P and Siersema PD critically reviewed the paper and made useful suggestions.
Correspondence to: Dr. Bas Oldenburg, Department of Gastroenterology, University Medical Center Utrecht, Heidelberglaan 100, Utrecht 3584CX, The Netherlands. b.oldenburg@umcutrecht.nl
Telephone: + 31-88-7555555
Fax: + 31-88-7555533
Received: August 15, 2008
Revised: October 29, 2008
Accepted: November 5, 2008
Published online: January 14, 2009
Abstract

AIM: 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.

CONCLUSION: 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.

Keywords: Colorectal cancer; Crohn’s disease; Dysplasia; Guidelines; Surveillance; Ulcerative colitis