Updated BSG guidelines for cancer surveillance in IBD – improving consensus and changing practice?
Bibliographic record
Abstract
Introduction BSG guidelines for screening and surveillance in IBD have been recently updated to account for changes in consensus opinion and evidence since their initial publication in 2002.1 2 Changes include use of pancolonic dye spray, suggested intervals between colonoscopies, and use of therapeutic endoscopy. The current work aims to assess contemporary practice, opinion and understanding among gastroenterologists in relation to the updated guidelines. Methods A questionnaire survey was electronically distributed to gastroenterology consultants and trainees within Severn and Wales deaneries. A 31.4% (37/118) response rate was achieved across 14 NHS trusts. Guidelines were available to all respondents. Results Variations in local protocols included the choice of bowel preparation, the number of ‘points’ allocated per colonoscopy (range 1–4), and in the targeting of colonoscopies to endoscopists with a special interest (35% of institutions). Pancolonic dye spray was used routinely by only 30% of respondents, with the majority (60%) employing the previously recommended strategy of taking two to four random biopsies at 10 cm intervals.2 The average number of biopsies taken during routine surveillance colonoscopy ranged from 4 to 50 (mean=18.83). A general consensus with guidelines in respect to the timing of initial screening colonoscopy, and of the surveillance intervals necessary in proctitis and pancolitis was demonstrated. Nonetheless, widespread confusion regarding optimum surveillance intervals in high risk groups (eg, PSC, family history) and in cases where definition of disease extent was unclear (eg, UC extending to sigmoid – classified as left sided disease by Montreal criteria3) was evident. With the notable exception of low grade dysplasia, lesion management was broadly consistent and in keeping with BSG guidelines. Responses were similar in both consultant (n=25) and trainee (n=12) groups. Conclusion A similar study undertaken in relation to the 2002 BSG guidelines highlighted widespread controversy and uncertainty surrounding IBD surveillance.4 Analysis of results from the current work suggest that, although the updated guidelines clarify some areas, notable variations in local and individual practice remain, and areas of confusion persist. In particular a reluctance to use pancolonic dye spray, uncertainty regarding surveillance intervals in high risk groups, a lack of clarity in classification of disease extent, and disparity in management of low grade dysplasia are demonstrated. If these findings are representative of opinion and understanding nationally, it would seem that uniform, quality surveillance in IBD is not yet accepted standard practice.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.052 | 0.135 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.006 | 0.006 |
| Science and technology studies | 0.001 | 0.003 |
| Scholarly communication | 0.005 | 0.007 |
| Open science | 0.003 | 0.005 |
| Research integrity | 0.006 | 0.008 |
| Insufficient payload (model declined to judge) | 0.006 | 0.002 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".