David DiCaprio1, Steven Lee-Kong2, Guillaume Stoffels3, Bo Shen4, Ahmed Al-Mazrou2, R P Kiran2, Burton Korelitz5, Arun Swaminath5. 1. Department of Gastroenterology, Lenox Hill Hospital Northwell Health, New York, NY, USA. dhdicaprio@gmail.com. 2. Division of Colorectal Surgery, New York Presbyterian/Columbia, New York, NY, USA. 3. Biostatistics Unit, Feinstein Institute of Research, New York, NY, USA. 4. Department of Gastroenterology and Hepatology, Cleveland Clinic, Cleveland, OH, USA. 5. Department of Gastroenterology, Lenox Hill Hospital Northwell Health, New York, NY, USA.
Abstract
PURPOSE: Patients with ulcerative colitis, a high-risk group for the development of colon cancer, undergo colonoscopy more frequently than the general population. This increase in endoscopic evaluation also exposes these patients to an increased risk of complications, including iatrogenic perforation. Our survey study aims to determine factors that affect the management choices for iatrogenic perforations for ulcerative colitis patients in remission and identify areas of consensus among general gastroenterologists, inflammatory bowel disease specialists, and colorectal surgeons. METHODS: An anonymous, cross-sectional survey was performed using an online platform. A matrix questionnaire posed five clinical scenarios with six management options for an iatrogenic perforation in ulcerative colitis patients with varying disease distribution, disease activity, and maintenance regimens. RESULTS: One hundred thirty-eight general gastroenterologists, 35 inflammatory bowel disease specialists, and 174 colorectal surgeons responded to the survey; 47, 41, and 23%, respectively, answered they did not feel comfortable managing perforations in ulcerative colitis patients in remission. We found the greatest concordance among gastroenterologists and colorectal surgeons in cases of perforation in ulcerative colitis with a history of dysplasia; the majority of respondents chose staged total proctocolectomy with ileal pouch anal anastomosis. We found discordance in decision making for ulcerative colitis in remission without dysplasia, with perforation occurring in colitis involved and uninvolved areas. CONCLUSION: Our survey revealed that a significant fraction of gastroenterologists and colorectal surgeons are uncomfortable managing iatrogenic colonic perforations in ulcerative colitis patients. We have identified knowledge and practice gaps in defining the optimal management of iatrogenic perforations in ulcerative colitis patients.
PURPOSE:Patients with ulcerative colitis, a high-risk group for the development of colon cancer, undergo colonoscopy more frequently than the general population. This increase in endoscopic evaluation also exposes these patients to an increased risk of complications, including iatrogenic perforation. Our survey study aims to determine factors that affect the management choices for iatrogenic perforations for ulcerative colitispatients in remission and identify areas of consensus among general gastroenterologists, inflammatory bowel disease specialists, and colorectal surgeons. METHODS: An anonymous, cross-sectional survey was performed using an online platform. A matrix questionnaire posed five clinical scenarios with six management options for an iatrogenic perforation in ulcerative colitispatients with varying disease distribution, disease activity, and maintenance regimens. RESULTS: One hundred thirty-eight general gastroenterologists, 35 inflammatory bowel disease specialists, and 174 colorectal surgeons responded to the survey; 47, 41, and 23%, respectively, answered they did not feel comfortable managing perforations in ulcerative colitispatients in remission. We found the greatest concordance among gastroenterologists and colorectal surgeons in cases of perforation in ulcerative colitis with a history of dysplasia; the majority of respondents chose staged total proctocolectomy with ileal pouch anal anastomosis. We found discordance in decision making for ulcerative colitis in remission without dysplasia, with perforation occurring in colitis involved and uninvolved areas. CONCLUSION: Our survey revealed that a significant fraction of gastroenterologists and colorectal surgeons are uncomfortable managing iatrogenic colonic perforations in ulcerative colitispatients. We have identified knowledge and practice gaps in defining the optimal management of iatrogenic perforations in ulcerative colitispatients.
Authors: Howard Ross; Scott R Steele; Mika Varma; Sharon Dykes; Robert Cima; W Donald Buie; Janice Rafferty Journal: Dis Colon Rectum Date: 2014-01 Impact factor: 4.585
Authors: Barbara Bielawska; Andrew G Day; David A Lieberman; Lawrence C Hookey Journal: Clin Gastroenterol Hepatol Date: 2013-07-23 Impact factor: 11.382