P788 Endoscopic management of patients with high-risk colorectal colitis-associated neoplasia: a Delphi study
Bak, M.(1,2)*;Albéniz, E.(3);East, J.(4,5);Coelho-Prabhu, N.(6);Suzuki, N.(7);Saito, Y.(8);Matsumoto, T.(9);Banerjee, R.(10);Kaminski, M.(11);Kiesslich, R.(12);Coron, E.(13);de Vries, A.(14);van der Woude, C.J.(14);Bisschops, R.(15);Hart, A.(16);Itzkowitz, S.(17);Pioche, M.(18);Moons, L.(1);Oldenburg, B.(1);
(1)University Medical Center Utrecht, Department of Gastroenterology and Hepatology, Utrecht, The Netherlands;(2)Erasmus University Medical Center Rotterdam, Department of Gastroenterology and Hepatology, Rotterdam, The Netherlands;(3)Hospital Universitario de Navarra HUN Navarrabiomed- Universidad Pública de Navarra UPNA- IdiSNA, Endoscopy Unit- Gastroenterology Department, Pamplona, Spain;(4)John Radcliffe Hospital- University of Oxford- and Oxford NIHR Biomedical Research Centre, Translational Gastroenterology Unit, Oxford, United Kingdom;(5)Mayo Clinic Healthcare, Division of Gastroenterology and Hepatology, London, United Kingdom;(6)Mayo Clinic, Department of Gastroenterology and Hepatology, Rochester- Minnesota, United States;(7)St Mark's Hospital and Academic Institute, Wolfson Unit for Endoscopy, Lodnon, United Kingdom;(8)National Cancer Center Hospital, Endoscopy Division, Tokyo, Japan;(9)School of Medicine- Iwate Medical University, Division of Gastroenterology- Department of Internal Medicine, Morioka- Iwate, Japan;(10)Asian Institute of Gastroenterology, Inflammatory Bowel Disease Center, Hyderabad, India;(11)Medical Center for Postgraduate Education, Department of Gastroenterology- Hepatology and Oncology, Warsaw, Poland;(12)Helios Dr Horst Schmidt Kliniken Wiesbaden, Medical Director, Wiesbaden, Germany;(13)University Hospital of Geneva HUG, Department of Gastroenterology and Hepatology, Genève, Switzerland;(14)Erasmus University Medical Center, Department of Gastroenterology and Hepatology, Rotterdam, The Netherlands;(15)University Hospitals Leuven- TARGID- KU Leuven-, Department of Gastroenterology and Hepatology, Leuven, Belgium;(16)St Mark's Hospital and Academic Institute, Department of Gastroenterology, London, United Kingdom;(17)Icahn School of Medicine at Mount Sinai, Dr. Henry D. Janowitz Division of Gastroenterology, New York- New York, United States;(18)Edouard Herriot Hospital- Hospices Civils de Lyon, Endoscopy and Gastroenterology Unit, Lyon, France;
Background
Current guidelines recommend endoscopic resection of visible and endoscopically resectable colorectal colitis-associated neoplasia (CAN) in patients with inflammatory bowel disease (IBD). However, patients with high risk CAN are often not amenable to conventional resections techniques and a consensus approach for the endoscopic management of these lesions is presently lacking. This Delphi study aims to reach consensus amongst experts on the endoscopic management of these lesions.
Methods
A three-round modified Delphi process was conducted to reach consensus amongst worldwide IBD and/or endoscopy experts (n=18) from three continents. Experts were chosen based on the extensive clinical experience with IBD and/or EMR/ESD in patients with IBD, and the authorship on multiple peer-reviewed publications on CAN, the endoscopic resection of CAN and/or EMR/ESD. Consensus was considered if ≥ 75% agreed or disagreed. Quality of evidence was assessed by the criteria of the Cochrane Collaboration group.
Results
Consensus was reached on all statements (n=14). Experts agreed on a definition for CAN and high-risk CAN (HR-CAN). Consensus was reached on the examination of the colon with enhanced endoscopic imaging prior to resection, the endoscopic resectability of a HR-CAN lesion and endoscopic assessment and standard report of CAN lesions. In addition, experts agreed on type of resections of HR-CAN (< 20mm, >20 mm, with or without good lifting), endoscopic success (technical success and outcomes), histologic assessment and follow-up in HR-CAN.
Conclusion
This is the first step in developing international consensus-based recommendations for endoscopic management of (HR-)CAN. Although the quality of available evidence was considered low, consensus was reached on several aspects of the management of (HR-)CAN. The present work and proposed standardization might benefit future studies.