Variability in the diagnosis and management of adenoma-like and non-adenoma-like dysplasia-associated lesions or masses in inflammatory bowel disease: an Internet-based study

Farraye, Francis A.; Waye, Jerome D.; Moscandrew, Maria; Heeren, Timothy C.; Odze, Robert D.

doi:10.1016/j.gie.2006.12.016

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Volume 66, Issue 3 , Pages 519-529, September 2007

Variability in the diagnosis and management of adenoma-like and non-adenoma-like dysplasia-associated lesions or masses in inflammatory bowel disease: an Internet-based study

Current affiliations: Section of Gastroenterology/Center for Digestive Disorders, Boston Medical Center, Boston, Massachusetts (F.A.F., M.M.), Mount Sinai Hospital, New York, New York (J.D.W.), Department of Biostatistics, Boston University School of Public Health, Boston, Massachusetts (T.C.H.), Brigham and Women's Hospital, Boston, Massachusetts (R.D.O.), USA

Received 20 July 2006; accepted 4 December 2006. published online 19 July 2007.

Boston, Massachusetts, New York, New York, USA

Background

Dysplasia-associated lesions or masses (DALMs) in inflammatory bowel disease (IBD) are a heterogeneous group of tumors with different natural histories.

Objectives

Our purpose was to determine the ability of gastroenterologists (GE) to distinguish adenoma-like (ALD) from non-adenoma-like DALMs (NALD) in patients with ulcerative colitis (UC) and to evaluate management practices with regard to these lesions.

Participants

Randomly chosen academic and private practice members of the American Society for Gastrointestinal Endoscopy and a group of IBD experts.

Design

All GEs answered a series of questions related to UC-associated DALMs and were asked to classify 13 digitally transmitted endoscopic images (5 ALD, 5 NALD, and 3 inflammatory polyps [IP]).

Setting

Internet-based survey.

Patients

Not applicable.

Interventions

Not applicable.

Main Outcome Measurements

Percentage of respondents who answered management questions and classified endoscopic images correctly.

Results

ALD, NALD, and IP were correctly diagnosed by 68%, 75%, and 82% of IBD experts; 58%, 56%, and 57% of academic gastroenterologists; and 60%, 73%, and 60% of private practice GEs, respectively. Overall, there were no significant differences in rates of correct diagnosis for the 3 types of polyps (P = .603). IBD experts showed a significantly higher correct diagnosis rate (P = .048) and interobserver agreement (P < .01) compared with the other two GE groups. Many GEs were not aware of the currently recommended management guidelines for patients with IBD with DALMs.

Limitations

Only a single endoscopic image was used in this study. The response rate was 32%.

Conclusion

These data suggest that academic GEs and private practice GEs have more difficulty than IBD experts do in distinguishing between and managing DALMs in patients with UC.

Abbreviations: ALD, adenoma-like, ASGE, American Society for Gastrointestinal Endoscopy, DALM, dysplasia-associated lesions or masses, GEs, gastroenterologists, GEE, generalized estimating equation, IBD, inflammatory bowel disease, IP, inflammatory polyps, NALD, non-adenoma-like, UC, ulcerative colitis