Elsevier

Gastrointestinal Endoscopy

Volume 82, Issue 4, October 2015, Pages 708-714.e4
Gastrointestinal Endoscopy

Original article
Clinical endoscopy
Knowledge and predictors of dysplasia surveillance performance in inflammatory bowel diseases in Australia

https://doi.org/10.1016/j.gie.2015.04.004Get rights and content

Background

Dysplasia surveillance is recognized as an integral component in the management of inflammatory bowel diseases (IBDs). The adherence to surveillance guidelines is variable, and understanding of quality indicators and predictors of behavior is currently limited.

Objective

To perform a nationwide evaluation of the quality of IBD surveillance practiced by Australian endoscopists and to determine the predictors of quality practice.

Design

Cross-sectional nationwide survey.

Setting

Survey distributed through the gastroenterology and colorectal surgery societies covering knowledge and practice of IBD surveillance.

Main Outcome Measurements

Adherence to indicators of high-quality surveillance and median score of IBD surveillance guideline knowledge.

Results

A total of 264 responses were received, comprising 240 respondents who perform surveillance screening (218 gastroenterologists, 46 colorectal surgeons). Gastroenterologists were significantly more likely to undertake surveillance (P < .001), adhere to guidelines (P = .02), use advanced imaging modalities (P = .04), and have greater surveillance knowledge than colorectal surgeons (P < .001). Knowledge score and gastroenterologists were independent predictors of dysplasia screening (odds ratio [OR] 1.66; 95% confidence interval [CI], 1.41-1.96 and OR 11.2; 95% CI, 4.53-27.87), guideline adherence (OR 1.15; 95% CI, 1.01-1.31 and OR 2.42; 95% CI, 1.11-5.30), and advanced endoscopic imaging technique use (OR 1.19; 95% CI, 1.05-1.35 and OR 2.2; 95% CI, 1.02-4.74).

Limitations

Potential responder bias results appear, however, aligned with those of previous studies.

Conclusions

IBD dysplasia surveillance in Australia is being performed at a high standard. Gastroenterology specialization and knowledge score have been demonstrated to be strong predictors of high-quality surveillance practice. This is the first study to determine predictors of screening behavior and quantify surveillance quality. These results further emphasize that gastroenterologists should play a key role in IBD surveillance.

Section snippets

Survey questionnaire and IBD surveillance knowledge score

A survey was developed to explore the broad range of factors that contribute to the quality of dysplasia surveillance. The themes focused on in other studies were further developed to provide more complete insight into Australian surveillance practice and to facilitate a quantification of performance. The structured survey was designed by a focus group of 3 gastroenterologists and comprised 22 self-administered questions (Appendix 1, available online at www.giejournal.org). The survey is a

Results

A total of 264 responses were obtained, 240 of which were from those who performed IBD surveillance endoscopies. Response rates were 53% for gastroenterologists and 36% for CRSs. Of the 24 nonscreening respondents, 38% were gastroenterologists and 62% were CRSs. Of the screening respondents, 218 were gastroenterologists and 46 were CRSs (7 gastroenterologists were also general internists and 3 CRSs also performed general surgery).

The majority of respondents were experienced practitioners, with

Discussion

Colorectal carcinoma remains the most devastating adverse event of chronic IBD, and surveillance colonoscopy forms part of an established management algorithm for IBD.25 Previous international studies revealed poor implementation of these programs and highly variable adherence to surveillance guidelines.19, 20, 21, 22, 23 However, progressive changes over time demonstrated improved guideline adherence in this, the first nationwide survey published in the past 10 years. This study also evaluated

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    DISCLOSURE: All authors disclosed no financial relationships relevant to this publication.

    See CME section; p. 718.

    If you would like to chat with an author of this article, you may contact Dr Leong at [email protected].

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