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Knowledge and predictors of dysplasia surveillance performance in inflammatory bowel diseases in Australia
Rupert W L Leong1, Jonathan Perry2, Brayden Campbell2
1Gastroenterology and Liver Services, Sydney Local Health District, Concord Hospital, Concord, New South Wales, Australia; Gastroenterology and Liver Services, Sydney South West Local Health Network, Bankstown Hospital, Bankstown, New South Wales, Australia; Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia; Faculty of Medicine, Sydney Medical School, Sydney, New South Wales, Australia.
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.
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