How gastroenterologists screen for colonic cancer in ulcerative colitis: an analysis of performance

Background: The aim of this study was to assess the colorectal cancer surve illance practices of British gastroenterologists for patients with ulcerati ve colitis, Methods: A questionnaire that investigated aspects of surveillance in patie nts with ulcerative colitis was mailed to all consultant gastroenterologist s in the U.K. (n = 413). Results: Three hundred forty-one questionnaires were returned (response rat e 83%). Ninety-four percent of consultants practice cancer surveillance in ulcerative colitis, with 35% maintaining a registry of patients in surveill ance programs, All gastroenterologists perform surveillance in patients wit h pancolitis, 24% in those with left-sided colitis and 2% in patients with proctitis, The mean duration of disease before surveillance is commenced is 9.2 years for pancolitis and 12.4 years for left-sided colitis (p < 0.0001 ), Only 4% of gastroenterologists routinely offer patients with disease of more than 10 years' duration a prophylactic colectomy, Colonoscopies are co nducted by an accredited gastroenterologist in 65% of cases and biopsies ar e reviewed by specialists in gastrointestinal pathology in 45%, When histol ogy reveals low-grade dysplasia only 4% advise colectomy and when high-grad e dysplasia is found 53% recommend colectomy. Sixteen percent of gastroente rologists were unaware of the significance of a dysplasia associated lesion or mass. Conclusion: The majority of gastroenterologists practice surveillance on a disorganized basis. There is inconsistency in the management of patients wi th dysplasia and education of gastroenterologists is needed.