Su1118 The Development of a Standardized Peri-Operative Steroid Management Protocol for IBD Patients

Abstract

Background: There are still no standard endoscopic surveillance guidelines to detect neoplasia (dysplasia and/or cancer) following IPAA for IBD colitis. The aim of this survey study is to investigate the practice pattern of surveillance pouchoscopy for neoplasia in academic settings. Methods: Physicians who potentially take care of patients undergoing IPAA for IBD colitis were identified by searching literatures in MEDLINE. A questionnaire including practice pattern and opinions on ileal pouch surveillance was sent by email through REDcap. Univariable and multivariable analyses were performed. Results: A total of 118 physicians (86 gastroenterologists and 32 colorectal surgeons) were surveyed and 58 (49%) of them responded. One incomplete questionnaire and 5 physicians who do not routinely followup IBD patients with ileal pouch were excluded. Of the 52 eligible participants from 32 institutions, 6 (11%) were general gastroenterologists, 31(60%) were gastroenterologists specialized in IBD and 15 (29%) were colorectal surgeons. Forty-one physicians (79%) agree that it is necessary to perform routine pouch surveillance for neoplasia arising from ileal pouch or anal transitional zone/rectal cuff in all IBD patients undergoing IPAA and 22 (55%) think that the pouchoacopy solely for neoplasia should be performed every 2-3 years. Thirtysix physicians (69%) feel that pouchoscopy with biopsy is effective for the detection of neoplasia. Altogether 41 dysplasias and 15 cancers arising from ileal pouch or anal transitional zone/rectal cuff were reported to have been found within the past 5 years by 18 physicians (35%). There were no differences in the locations of pouch observation and biopsy during pouchocsopy examination between neoplasia detection and non-detection group. Colorectal surgeons found more pouch neoplasias than both gastroenterologists specialized in IBD and general gastroenterologists (61% vs 28% vs 11%, p 3 biopsies per location, 44% vs 82%, p=0.005). The median follow-up number of IBD pouch per year was significantly higher in neoplasia detection group (50 vs 25, p=0.041).