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Endoscopic Surveillance for Colorectal Cancer in Pediatric Ulcerative Colitis: A Survey Among Dutch Pediatric
Jasmijn Z Jagt1,2, Daniëlle A van Schie3, Marc A Benninga4
1From the Department of Pediatric Gastroenterology, Emma Children's Hospital, Amsterdam University Medical Centre, VU University Amsterdam, Amsterdam, The Netherlands.
Insights
Dutch pediatric gastroenterologists show varied practices in colorectal cancer surveillance for children with ulcerative colitis (UC). Guidelines are followed by many, but significant heterogeneity exists in surveillance initiation, intervals, and techniques, necessitating updated guidelines.
Area of Science:
- Pediatric Gastroenterology
- Colorectal Cancer Research
- Inflammatory Bowel Disease Management
Background:
- Pediatric ulcerative colitis (UC) increases colorectal cancer risk.
- Current surveillance practices among Dutch pediatric gastroenterologists are not well-defined.
- Standardized surveillance protocols are crucial for early detection and improved outcomes.
Purpose of the Study:
- To evaluate current clinical practices for colorectal dysplasia and cancer surveillance in pediatric UC patients in the Netherlands.
- To assess adherence to existing guidelines, surveillance initiation and intervals, and endoscopy techniques.
- To identify areas for improvement in surveillance strategies for pediatric UC.
Main Methods:
- A clinical vignette-based survey was distributed to 47 Dutch pediatric gastroenterologists.
- A response rate of 70% was achieved, with 33 participants completing the questionnaire.
- Survey data focused on surveillance practices, guideline adherence, and preferred techniques.
Main Results:
- 70% of respondents perform endoscopic surveillance in pediatric UC patients.
- 82% reported adherence to available guidelines, yet 77% called for a new guideline.
- Significant variation exists in surveillance initiation, intervals, and risk factor consideration (e.g., disease extent, PSC).
- Chromoendoscopy, recommended by guidelines, was used by only 8%, while 50% used conventional endoscopy with random biopsies.
Conclusions:
- Heterogeneity in surveillance practices highlights the need for consistent, updated guidelines.
- Future research should focus on UC-associated colorectal cancer risks and optimal endoscopy techniques in pediatric patients.
- Standardized surveillance protocols are essential for effective management of pediatric UC and cancer prevention.
Objectives:
This study aimed to evaluate the current clinical practice of Dutch pediatric gastroenterologists regarding the surveillance for colorectal dysplasia and cancer in pediatric ulcerative colitis (UC), including adherence to guidelines, the initiation and interval of surveillance and applied endoscopy techniques.
Methods:
A clinical vignette-based survey was distributed among all 47 pediatric gastroenterologists who are registered and working in the Netherlands.
Results:
Thirty-three pediatric gastroenterologists treating children with UC, completed the questionnaire (response rate 70%). Of these respondents, 23 (70%) do conduct endoscopic surveillance in their UC patients. Adherence to any of the available guidelines was reported by 82% of respondents. Twenty-four of 31 respondents (77%) indicated the need for development of a new guideline. Profound variation was witnessed concerning the initiation and interval of surveillance, and risk factors taken into consideration, such as disease extent and concomitant diagnosis of primary sclerosing cholangitis (PSC). The available national and European guidelines recommend the use of chromoendoscopy in the performance of surveillance. This technique was conducted by 8% of respondents, whereas 50% conducted conventional endoscopy with random biopsies.
Conclusions:
The heterogeneity in surveillance practices underlines the need for consistency among the guidelines, explicitly stated by 77% of the respondents. For this, future research on surveillance in pediatric UC is warranted, focusing on the risk of UC-associated colorectal cancer related to risk factors and optimal endoscopy techniques.
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