Optimizing the quality of endoscopy in inflammatory bowel disease: focus on surveillance and management of colorectal dysplasia using interactive image- and video-based teaching

• Published in: Gastrointestinal endoscopy 2017-12, Vol.86 (6), p.1107-1117.e1
• Main Authors: Kaltenbach, Tonya R., Soetikno, Roy M., DeVivo, Rebecca, Laine, Loren A., Barkun, Alan, McQuaid, Kenneth R., Cheifetz, Adam, Chiorean, Michael, East, James E., Farraye, Francis A., Leighton, Jonathan A., Levesque, Barrett G., Lichtenstein, Gary R., Marion, James F., Matsumoto, Takayuki, Mönkemüller, Klaus, Picco, Michael F., Odze, Robert, Raju, Gottumukkala S., Rutter, Matt, Rex, Douglas K., Shen, Bo, Shergill, Amandeep, Subramanian, Venkat
• Format: Article
• Language: English
• Subjects: Biopsy; Colon - diagnostic imaging; Colon - pathology; Colonic Polyps - diagnostic imaging; Colonic Polyps - etiology; Colonic Polyps - pathology; Colonoscopy - education; Colonoscopy - methods; Colonoscopy - standards; Color; Colorectal Neoplasms - diagnostic imaging; Colorectal Neoplasms - etiology; Colorectal Neoplasms - pathology; Education, Medical, Continuing - methods; Humans; Inflammatory Bowel Diseases - complications; Inflammatory Bowel Diseases - diagnostic imaging; Practice Guidelines as Topic; Practice Patterns, Physicians; Quality Improvement; Rectum - diagnostic imaging; Rectum - pathology; Simulation Training; Watchful Waiting
• ISSN: 0016-5107; 1097-6779
• DOI: 10.1016/j.gie.2017.07.045

Varying recommendations regarding the detection and management of dysplasia can lead to uncertainty and may impede the uptake of strategies that could improve surveillance in patients with inflammatory bowel disease (IBD). An educational event was held to assist in disseminating the recently published Surveillance for Colorectal Endoscopic Neoplasia Detection and Management in Inflammatory Bowel Disease Patients: International Consensus Recommendations (SCENIC). Specialists in IBD and endoscopy led the Optimizing Quality of Endoscopy in IBD course. The American Society for Gastrointestinal Endoscopy (ASGE) organized the course, and the Crohn’s and Colitis Foundation of America (CCFA) provided endorsement. One was held in March 2015 at the ASGE Institute for Training and Technology in Chicago, Illinois, and the second in September 2016 preceding the ASGE Endofest in Chandler, Arizona. The program included interactive case-based discussions and didactic presentations on topics including the rationale and current approach of surveillance in IBD; endoscopic characterization and nomenclature of active and quiescent disease; detection of dysplasia during IBD surveillance; role of image-enhanced endoscopy in IBD surveillance, with a focus on chromoendoscopy technique; and management of dysplasia in IBD. Participants were surveyed before and after the course to assess their perspectives and practice. Eighteen presenters or panel members and approximately 92 IBD and endoscopist physician leaders attended the meeting. Most attendees were aged 30 to 49 years (88.1%), had been in practice less than 10 years (89.7%), were from academic medical centers (90.7%), and spent >50% of their time caring for patients with IBD (59.7%). Recommended quality improvements for endoscopy in IBD included the use of endoscopic scoring systems to describe disease activity, the use of a modified Paris classification to characterize visible dysplastic lesions (polypoid, nonpolypoid with description of presence of ulcer and distinct or indistinct borders), the use of chromoendoscopy for dysplasia detection, and the endoscopic removal of visible dysplastic lesions. In the follow-up survey, participants were asked to indicate whether they had changed their practice as a result of attending the course. Ninety-three percent (93%) indicated they had changed their practice. For dysplasia detection, the use of chromoendoscopy increased: 51.7% of respondents reported using chromoendoscopy in most s