Endoscopic Modalities for the Detection of Neoplasia in Inflammatory Bowel Disease: Access, Perceptions, and Practices
Bibliographic record
Abstract
Introduction: The recognition that patients with inflammatory bowel disease are at higher risk of developing colorectal cancer relative to the general population has led to the development of specific recommendations for dysplasia surveillance in this patient population by multiple national societies. The latest SCENIC consensus guidelines have recommended dye based chromonendoscopy (DBC) as the preferred method for endoscopic dysplasia surveillance in patients with inflammatory bowel disease, compared to white-light endosocopy with random biopsies. We sought to examine the uptake of, and perception towards DBC among academic gastroenterologists. Methods: We conducted an online survey of academic members of the Canadian Association of Gastroenterology to assess their current dysplasia surveillance practice, uptake of and perceived barriers to adoption of DBC. We collected information about practice characteristics (years in practice, subspecialty training in IBD and proportion of IBD patients in respondent's practice) as well as colonoscopy surveillance patterns (annual volume of dysplasia surveillance colonoscopies for IBD patients, adherence to any recent major society screening guideline, preferred screen interval, and number of biopsies taken per colonoscopy). We also assessed uptake of several advanced image-enhanced endoscopy, including DBC, dye-less chromoendoscopy and confocal laser endomicroscopy (Figure 1).Figure 1Results: 49 of 150 (32.7%) physicians responded to the survey. The majority of respondents reported subspecialty training in IBD (71.4%) and the median number of years in practice was 12 years. The results of the beliefs and attitudes survey are shown in Table 2. White-light endoscopy with random colonic biopsy was the preferred dysplasia screening method (73.5%). Only 26.5% of respondents routinely used DBC, despite institutional availability of over 60% (Figure 2). The major barriers to adoption of DBC were concerns about procedural time length (46.9%), concerns about cost (44.9%) and inadequate training (40.8%) (Figure 3).Figure 2Figure 3Conclusion: There is low uptake of DBC for dysplasia surveillance in IBD patients among academic gastroenterologists practicing in Canada. The major barriers to uptake of DBC were cost, time commitment and lack of training. Improved physician education and increased access to newer endoscopic resources may improve adherence to recommendations and reduce heterogeneity in physicians' practices, with overall improvement in the care provided to IBD patients.Table 1: Gastroenterologists' beliefs and perceptions regarding of surveillance colonoscopy
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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 | 0.002 | 0.008 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.003 | 0.000 |
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".