Physicians' perceptions of dysplasia and approaches to surveillance colonoscopy in ulcerative colitis

Objective : Colonoscopic biopsy surveillance to detect dysplasia, defined as a neoplastic change of the epithelium without invasion into the lamina propria, in patients with ulcerative colitis has become a widespread practice. We undertook a survey study to determine physicians' perceptions of, and approaches to, dysplasia surveillance colonoscopy in ulcerative colitis. Methods : Members of two regional gastroenterology associations in the United States, including both academic and private practice-based gastroenterologists, and a group of senior gastroenterology trainees were surveyed by means of a written questionnaire. The questionnaires were distributed at three separate meetings of practicing gastroenterologists or trainees : 1) a Gastrointestinal pathology course for second-year gastroenterology fellows from training programs around the United States (February 1993, Los Angeles, CA) ; 2) a meeting of the Southern California Gastroenterology Society (March 1993, Los Angeles, CA) ; and 3) a meeting of the Pacific Northwest Gastroenterology Society (June 1993, Seattle, Washington). The percentages of all responses were tallied and analyzed for the group as a whole as well as by subgroup analysis. Understanding of the definition of dysplasia and specific practice techniques and approaches were the main outcomes sought. Results : Only 19% of respondents correctly identified the definition of dysplasia. More respondents (48%) correctly defined high grade dysplasia specifically compared with only 16% who correctly defined low grade dysplasia. The majority of respondents (69%) recommended colectomy when high grade dysplasia was diagnosed, yet nearly one-third of respondents pursued continued surveillance in this setting. Almost uniformly, respondents pursued continued surveillance and not colectomy when low grade dysplasia was diagnosed. Nearly one-half of the respondents thought that there was only <20% chance of finding invasive cancer in patients with preoperative