P054 IBD Associated Surveillance Dysplasia Program: New Integrated Model: Audit, Summary, Future Directions and Literature Review
Authors: Kashani Irwin 
Published: December 2021

BACKGROUND:

The recommended commencement of screening for dysplasia in IBD cases is after 8-year duration with at least E2 disease, that is proximal to the rectosigmoid junction (∼15cm) or L2 or L3 Crohn’s disease involving at least one-third of the colon. At this time, the risk of colonic IBD patients having CRC approaches 1%. Exceptions: (Early starters) people with a diagnosis of PSC with concurrent IBD suggest surveillance starts annually from the date of PSC diagnosis. Those with an FDR with CRC should commence screening 10 years prior to the age of diagnosis of the affected relative. Surveillance of the ileoanal pouch following restorative proctectomy is not commented on in the new guidelines. It is usually not recommended in the absence of high-risk features (ASGE, ECCO and BSG Guidelines): PSC diagnosis, CRC or dysplasia in the resected colon, Type C pouch mucosa or Refractory pouchitis.

METHODS:

The aim of the multidisciplinary team (MDT) is to improve the pathway for surveillance procedures, allocate resources appropriately and identify patients for research and trials. Cases were mainly referred from the prospective months booking database. Each case that is included in the monthly MDT meeting is discussed to ensure it is appropriate/consistent with guidelines with the assistance of administrative and data managers. We collate the cases with IBD database and risk calculator, assess and prescribe bowel prep, record outcome and communicate any changes, identify patients for studies and ensure we allocate patients to appropriate endoscopy lists.

RESULTS:

Over a course of 12 meetings conducted monthly, a total of 356 cases were screened with 91 cases eligible of which 62 cases were considered suitable in meeting inclusion criteria. The majority of these cases were UC (E3/E2) (n = 56), Crohn’s (n = 27), colonic IBD (n = 7) and IBD-U (n = 1). The majority of cases were deemed in the high-risk category for colorectal cancer (43/62). Previous known dysplasia cases were limited (two cases with adenoma). There were 17 cases with PSC (seven were large duct). Family history of dysplasia was not strongly represented. Ten new cases of PSC being investigated were identified early prior to hepatology review or critical investigations. There were ten pouchscopy cases. There were a significant number of deferrals, cancellations and reassignments identified (n = 16). Four procedures were cancelled, eight cases reassigned due to extensive pseudo polyps and 17 were placed on PSC annual surveillance. We also identified significant bowel prep deficiencies in 18 cases requiring prescriptions. IE or chromoendoscopy was identified as a potential area of improvement. A three-point specified allocation to colonoscopy lists was lacking, possibly mainly due to COVID 19 backlog of cases. The areas of improvement included attracting referrals from other settings other than the monthly booking file data (e.g hepatology clinic) and improving long-term attendance.

CONCLUSION:

The IBD surveillance MDT is a clinically useful tool that demonstrates significant improvement in quality and procedure reallocation. Although resource allocation is required, this clinical model can ensure that all IBD dysplasia surveillance cases including those with challenging risk factors or those outside the evidence based guidelines are appropriately monitored.