Physicians' Perceptions of Dysplasia and Approaches to Surveillance Colonoscopy in Ulcerative Colitis

Colonoscopic biopsy surveillance to detect dysplasia. defined as a neoplaslic change of tbe epithelium without invasion info the lamina propria. in patients with ulcerative colitis has become a widespread practice. We undertook a survey study to determine physicians' perceptions of, and approaches to, dysphtsia surveillance colonoscopy in ulcerative colitis. Members of two regional gastroenterology associations in the United States, including both academic and private practice‐based gastroenterologists, and a group of senior gastrocnlerology trainees were surveyed by means of a written questionnaire. The questionnaires were distributed at three separate meetings of practicing gaslroenterologists or trainees: 1) a Gastrointestinal pathology course for second‐year gastroenterology fellows from training programs around the United States (Februan 1993, Los Angeles, CA); 2) a meeting of the Southern California Gastroenterology Society (March 1993, Los Angeles, CA); and 3) a meeting of the Pacific Northwest Gastroenlerology Society (June 1993, Seattle, Washington). The percentages of all responses were tallied and analtzed for the group as a whole as well as by subgroup analysis. Understanding of the definition of dysplasia and specific practice techniques and approaches were the main outcomes sought. Only 19% of respondents correctly identified the definition of dysplasia. More respondents (48%) correctly defined high grade dysplasia specifically compared with only 16% who correctly defined low grade dysplasia. The majority of respondents (69%) recommended colectomy when high grade dysplasia was diagnosed, yet nearly one‐third of respondents pursued continued surveillance in this setting. Almost uniformly, respondents pursued continued surveillance and not colectomy when low grade dysplasia was diagnosed. Nearly one‐half of the respondents thought that there was only