Institute of Translational Medicine and Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK.
Department of Gastroenterology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK.
Dig Endosc. 2020 May;32(4):592-599. doi: 10.1111/den.13521. Epub 2019 Nov 3.
Dye-based chromoendoscopy (DCE) with targeted biopsies is recommended for inflammatory bowel disease (IBD) surveillance. However, DCE has not yet been widely adopted into clinical practice. We evaluated quality indicators in IBD surveillance following introduction of structured changes in service delivery.
In August 2016, we introduced a number of changes to IBD surveillance practice in our endoscopy unit. These included training using interactive videos/images in a structured module, DCE as standard by using a foot-pedal operated pump jet, allocation of 45-minute procedure timeslots, targeted biopsies (except in high-risk patients), scoring of endoscopic disease activity, and lesion detection/morphology characterization. All IBD surveillance colonoscopies were allocated to a small team of four DCE-trained endoscopists. We compared quality measures for surveillance procedures carried out pre- and post-August 2016. The two groups were compared using chi-squared statistics RESULTS: A total of 598 IBD surveillance procedures (277 pre-August 2016 and 321 post-August 2016) were done and included in the study. Use of DCE increased (54.2% vs 76.0% P < 0.0005) whereas random biopsy surveillance decreased (12.3% vs 3.1% P < 0.0005). Use of Paris classification (26.1% vs 57.0% P < 0.0005) and Kudo pit pattern increased (21.7% vs 59.0% P < 0.0005). There was also an increase in lesion detection rate (24.9% vs 33.1% P < 0.05).
Implementation of extensive changes in practice of surveillance colonoscopy resulted in significant improvement in quality indicators within a short period of time. Training, education and audit may continue to facilitate the adoption of DCE and further improve quality of performance in IBD surveillance.
靶向活检的染料基 chromoendoscopy（DCE）被推荐用于炎症性肠病（IBD）的监测。然而，DCE 尚未广泛应用于临床实践。我们评估了在引入服务提供的结构性改变后，在 IBD 监测中质量指标的变化。
2016 年 8 月，我们在我们的内镜单位引入了一系列 IBD 监测实践的改变。这些改变包括使用结构化模块中的互动视频/图像进行培训、标准使用脚踏操作的喷射泵进行 DCE、分配 45 分钟的程序时间、靶向活检（高危患者除外）、内镜疾病活动评分和病变检测/形态特征。所有 IBD 监测结肠镜检查都分配给一个由四名受过 DCE 培训的内镜医生组成的小团队。我们比较了 2016 年 8 月前和 2016 年 8 月后进行的监测程序的质量措施。使用卡方检验比较两组数据。
共有 598 例 IBD 监测程序（277 例在 2016 年 8 月前，321 例在 2016 年 8 月后）被纳入研究。DCE 的使用增加（54.2%比 76.0%，P<0.0005），而随机活检监测减少（12.3%比 3.1%，P<0.0005）。使用巴黎分类（26.1%比 57.0%，P<0.0005）和 Kudo 坑模式增加（21.7%比 59.0%，P<0.0005）。病变检出率也有所增加（24.9%比 33.1%，P<0.05）。
在短时间内，在监测结肠镜检查的实践中实施广泛的改变，显著改善了质量指标。培训、教育和审计可能会继续促进 DCE 的采用，并进一步提高 IBD 监测的绩效质量。
