P10 Addressing missed surveillance colonoscopies in ulcerative colitis – a role for automated systems. (19th June 2022)

• Record Type: Journal Article
• Authors: Carlson, Sean; Talabi, Yemi; Harrow, Paul
• Is Part Of: Gut. Volume 71(2022)Supplement 1
• Page Start: A40
• Page End: A40
• Publication Date: 2022-06-19
• Subjects: Gastroenterology -- Periodicals; 616.33
• DOI: 10.1136/gutjnl-2022-BSG.72
• Languages: English
• ISSNs: 0017-5749

Abstract

Abstract : Introduction: Longstanding ulcerative colitis (UC) increases the risk of developing colorectal cancer (CRC). Clinical guidelines provide timeframes and indications for colonoscopy surveillance in colitis. The aim of this audit was to determine the proportion of UC patients overdue 5 yearly surveillance in a central London teaching hospital and to risk stratify those patients based on BSG guidance. Methods: Every patient with a coded diagnosis of UC was identified using a search of electronic healthcare records (EHR) on the 01/05/2021. Patients not seen in gastroenterology clinic in the last 2 years, who had never had a colonoscopy and IBD gastroenterology clinic, or who had a date of death on EHR were excluded; the remaining patients were deemed to be UC patients under the care of UCLH IBD team. Patients diagnosed with UC less than 10 years ago, proctitis only, previous panproctocolectomy or had refused surveillance were excluded. Patients with a colonoscopy within 5 years were excluded. Results: 2570 patients had a coded diagnosis of UC on EHR, and 1361 patients met inclusion criteria. A total of 103 UC patients had not had a surveillance colonoscopy for more than 5 years. This represents 10.2% of eligible UC patients. The median age of patients overdue surveillance colonoscopies was 48 years old and 54% were female. Mean time since diagnosis of UC was 18.5 years and 13.3% of patients were deemed to have active disease by last physician global assessment. Median faecal calprotectin was 65.5µg/g. The majority of patients were on mesalazine (80.6%) with only 13.4% on immunomodulators or biologics. Using BSG risk stratification, 66.1% of patients were low risk, 25.2% medium and 8.7% high risk. Only 23% of patients had surveillance colonoscopies ordered on EHR suggesting the main reason for delay was not endoscopy service pressures. Conclusions: A tenth of all UC patients eligible for surveillance in a large tertiary IBD service had not had a colonoscopy for more than 5 years. This represents a significant clinical risk and is likely an underestimate of the unmet need for surveillance due to a minority of patients falling into higher risk categories needing more frequent surveillance. There are significant pressures in endoscopy departments across the country, but in this cohort the majority of patients did not have a request for surveillance. The lack of a systematic process meant requests depended on the reviewing clinician. Many EHR systems have physician support tools and automated processes which could prevent these omissions.