Variability in the diagnosis and management of adenoma-like and non-adenoma-like dysplasia-associated lesions or masses in inflammatory bowel disease: an Internet-based study

Abstract

Background: Dysplasia-associated lesions or masses (DALMs) in inflammatory bowel disease (IBD) are a heterogeneous group of tumors with different natural histories.

Objectives: Our purpose was to determine the ability of gastroenterologists (GE) to distinguish adenoma-like (ALD) from non-adenoma-like DALMs (NALD) in patients with ulcerative colitis (UC) and to evaluate management practices with regard to these lesions.

Participants: Randomly chosen academic and private practice members of the American Society for Gastrointestinal Endoscopy and a group of IBD experts.

Design: All GEs answered a series of questions related to UC-associated DALMs and were asked to classify 13 digitally transmitted endoscopic images (5 ALD, 5 NALD, and 3 inflammatory polyps [IP]).

Setting: Internet-based survey.

Patients: Not applicable.

Interventions: Not applicable.

Main outcome measurements: Percentage of respondents who answered management questions and classified endoscopic images correctly.

Results: ALD, NALD, and IP were correctly diagnosed by 68%, 75%, and 82% of IBD experts; 58%, 56%, and 57% of academic gastroenterologists; and 60%, 73%, and 60% of private practice GEs, respectively. Overall, there were no significant differences in rates of correct diagnosis for the 3 types of polyps (P=.603). IBD experts showed a significantly higher correct diagnosis rate (P=.048) and interobserver agreement (P<.01) compared with the other two GE groups. Many GEs were not aware of the currently recommended management guidelines for patients with IBD with DALMs.

Limitations: Only a single endoscopic image was used in this study. The response rate was 32%.

Conclusion: These data suggest that academic GEs and private practice GEs have more difficulty than IBD experts do in distinguishing between and managing DALMs in patients with UC.