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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
- Source :
- Journal of Crohn's & Colitis
- Publication Year :
- 2021
- Publisher :
- Oxford University Press, 2021.
-
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.<br />Graphical Abstract
- Subjects :
- medicine.medical_specialty
Dysplasia
Health Knowledge, Attitudes, Practice
Internationality
Colorectal cancer
medicine.medical_treatment
Colonoscopy
colorectal cancer
Risk Assessment
Chromoendoscopy
Surveys and Questionnaires
Medicine
Humans
Colitis
Practice Patterns, Physicians'
Colectomy
AcademicSubjects/MED00260
Hyperplasia
medicine.diagnostic_test
business.industry
General surgery
Gastroenterologists
Gastroenterology
Cancer
General Medicine
Original Articles
medicine.disease
Cross-Sectional Studies
surveillance
Colitis, Ulcerative
business
Cancer risk
Colorectal Neoplasms
Precancerous Conditions
Subjects
Details
- Language :
- English
- ISSN :
- 18764479 and 18739946
- Volume :
- 16
- Issue :
- 1
- Database :
- OpenAIRE
- Journal :
- Journal of Crohn's & Colitis
- Accession number :
- edsair.doi.dedup.....628d11abb99eabe7df4b3f34876fd66c