Endoscopy 1999; 31(8): 647-653
DOI: 10.1055/s-1999-126
Special Topic
Georg Thieme Verlag Stuttgart ·New York

11. Appropriateness of Colonoscopy: Inflammatory Bowel Disease [1]

F. Froehlich * , T. Larequi-Lauber ** , J.-J. Gonvers * , R. W. Dubois *** , B. Burnand *, ** , J.-P. Vader ***
  • * Policlinique Médicale Universitaire, Lausanne, Switzerland
  • ** Institut Universitaire de Médecine Sociale et Préventive, Lausanne, Switzerland
  • *** Protocare Sciences, Santa Monica, USA
Further Information

Publication History

Publication Date:
31 December 1999 (online)

Introduction

The use of colonoscopy to diagnose and follow up patients with inflammatory bowel disease is widely accepted. However, there is considerable uncertainty as to when colonoscopy is appropriate with respect to clinical symptoms, response to treatment and results of previous investigations. Uncertainty is even more important regarding the most appropriate use of colonoscopy in cancer screening in IBD.

In November 1998, a multidisciplinary European expert panel convened in Lausanne, Switzerland, to discuss and develop criteria for the appropriate use of gastrointestinal endoscopy, a widely-used procedure, regarded as highly accurate and safe. The RAND appropriateness method was chosen for this purpose, because it allows the development of appropriateness criteria based on published evidence and supplemented by explicit expert opinion. A detailed description of the RAND appropriateness method, including the literature search process [1], and of the whole process, as well as the global results of the panel [2], are published as separate articles in this issue of the Journal. The literature review was based on a systematic search of Medline, Embase and the Cochrane Library conducted up to the end of 1997 and completed with some key articles published in 1998. Updating and revision of the literature review is currently ongoing.

This article presents the literature review on IBD that was provided to the panelists for study and comment prior to the panel to support their ratings of appropriateness of colonoscopy in IBD. In addition, an overview of the main panel results related to IBD and a summary of published evidence and panel based appropriateness criteria are presented.

1 The European Panel on Appropriateness of Gastrointestinal Endoscopy (EPAGE, Lausanne, Switzerland)

References

  • 1 Vader J P, Burnand B, Froehlich F, Dubois R W, Bochud M, Gonvers J J. The European Panel on Appropriateness of Gastrointestinal Endoscopy (EPAGE): Project and methods.  Endoscopy. 1999;  31 572-578
  • 2 Vader J P, Froehlich F, Dubois R W, Beglinger C, Wietlisbach V, Pittet V, Ebel N, Gonvers J J, Burnand B. The European Panel on the Appropriateness of Gastrointestinal Endoscopy (EPAGE): Conclusions and WWW site.  Endoscopy. 1999;  31 687-694
  • 3 Rutgeerts P, Vantrappen G, Geboes K. Endoscopy in inflammatory bowel disease.  Scand J Gastroenterol Suppl. 1989;  170 12-15
  • 4 Mantzaris G J, Hatzis A, Archavlis E, Petraki K, Lazou A, Triantafyllou G, Raptis S A. The role of colonoscopy in the differential diagnosis of acute, severe hemorrhagic colitis.  Endoscopy. 1995;  27 645-653
  • 5 Schumacher G, Sandstedt B, Kollberg B. A prospective study of first attacks of inflammatory bowel disease and infectious colitis - Clinical findings and early diagnosis.  Scand J Gastroenterol. 1994;  29 265-274
  • 6 Geboes K, Delabie J, Rutgeerts P, Vantrappen G. Endoscopy as a diagnostic tool in inflammatory bowel disease.  Acta Chirurgica Belgica. 1989;  89 106-110
  • 7 Podolsky D K. Inflammatory bowel disease (1).  N Engl J Med. 1991;  325 928-937
  • 8 Podolsky D K. Inflammatory bowel disease (2) (see comments).  N Engl J Med. 1991;  325 1008-1016
  • 9 Farmer R G, Easley K A, Rankin G B. Clinical patterns, natural history, and progression of ulcerative colitis. A long-term follow-up of 1116 patients.  Dig Dis Sci. 1993;  38 1137-1146
  • 10 Langholz E, Munkholm P, Davidsen M, Nielsen O H, Binder V. Changes in extent of ulcerative colitis: a study on the course and prognostic factors.  Scand J Gastroenterol. 1996;  31 260-266
  • 11 Carbonnel F, Lavergne A, Lemann M, Bitoun A, Valleur P, Hautefeuille P, Galian A, Modgliani R, Rambaud J C. Colonoscopy of acute colitis. A safe and reliable tool for assessment of severity.  Digestive Diseases & Sciences. 1994;  39 1550-1557
  • 12 Hanauer S B, Sninksy C A, Robinson M, Powers B Y, McHattie J D, Mayle J E, Elson C O, DeMicco M P, Butt J H, Pruitt R E, et al. An oral preparation of mesalamine as long-term maintenance therapy for ulcerative colitis. A randomized, placebo-controlled trial.  Ann Intern Med. 1996;  124 204-211
  • 13 Courtney M G, Nunes D P, Bergin C F, O'Driscoll M, Trimble V, Keeling P W, Weir D G. Randomised comparison of olsalazine and mesalazine in prevention of relapses in ulcerative colitis.  Lancet. 1992;  339 1279-1281
  • 14 Landi B, Anh T N, Cortot A, Soule J C, Rene E, Gendre J P, Bories P, See A, Metman E H, Florent C, et al. Endoscopic monitoring of Crohn's disease treatment: a prospective, randomized clinical trial: The Groupe d'Etudes Therapeutiques des Affections Inflammatoires Digestives.  Gastroenterology. 1992;  102 1647-1653
  • 15 Farmer R G, Whelan G, Fazio VW. Long-term follow-up of patients with Crohn's disease. Relationship between the clinical pattern and prognosis.  Gastroenterology. 1985;  88 1818-1825
  • 16 Bo-Linn G W, Vendrell D D, Lee E, Fordtran J S. An evaluation of the significance of microscopic colitis in patients with chronic diarrhea.  Journal of Clinical Investigation. 1985;  75 1559-1569
  • 17 Rutgeerts P, Lofberg R, Malchow H, Lamers C, Olaison G, Jewell D, Danielsson A, Goebell H, Thomsen O O, Lorenz-Meyer H, et al. A comparison of budesonide with prednisolone for active Crohn's disease.  N Engl J Med. 1994;  331 842-845
  • 18 Greenberg G R, Feagan B G, Martin F, Sutherland L R, Thomson A B, Williams C N, Nilsson L G, Persson T. Oral budesonide for active Crohn's disease. Canadian inflammatory bowel disease study group.  N Engl J Med. 1994;  331 836-841
  • 19 Vasen H F, Taal B G, Nagengast F M, Griffioen G, Menko F H, Kleibeuker J H, Offerhaus G J, Meera Khan P. Hereditary nonpolyposis colorectal cancer: results of long-term surveillance in 50 families.  Eur J Cancer. 1995;  31 1145-1148
  • 20 Greenstein A J, Sachar D B, Smith H, Janowitz H D, Aufses A H. A comparison of cancer risk in Crohn's disease and ulcerative colitis.  Cancer. 1981;  48 2742-2745
  • 21 Ekbom A, Helmick C, Zack M, Adami H O. Ulcerative colitis and colorectal cancer. A population-based study.  N Engl J Med. 1990;  323 1228-1233
  • 22 Bernstein C N, Shanahan F, Weinstein W M. Are we telling patients the truth about surveillance colonoscopy in ulcerative colitis?.  Lancet. 1994;  343 71-74
  • 23 Ransohoff D F. Colon cancer in ulcerative colitis.  Gastroenterology. 1988;  94 1089-1091
  • 24 Jain S K, Peppercorn M A. Inflammatory bowel disease and colon cancer - a review.  Digestive Diseases. 1997;  15 243-252
  • 25 Lindberg B, Persson B, Veress B, Ingelman-Sundberg H, Granqvist S. Twenty years' colonoscopic surveillance of patients with ulcerative colitis. Detection of dysplastic and malignant transformation.  Scan J Gastroenterol. 1996;  31 1195-1204
  • 26 Connell W R, Lennard-Jones J E, Williams C B, Talbot I C, Price A B, Wilkinson K H. Factors affecting the outcome of endoscopic surveillance for cancer in ulcerative colitis (see comments).  Gastroenterology. 1994;  107 934-944
  • 27 Dyck W P, Cloud M L, Offen W W, Matsumoto C, Chernish S M. Treatment of duodenal ulceration in the United States.  Scand J Gastroenterol Suppl. 1987;  136 47-55
  • 28 Melville D M, Jass J R, Morson B C, Pollock D J, Richman P I, Shepherd N A, Ritchie J K, Love S B, Lennard-Jones J E. Observer study of the grading of dysplasia in ulcerative colitis: comparison with clinical outcome.  Hum Pathol. 1989;  20 1008-1014
  • 29 Dixon M F, Brown L J, Gilmour H M, Price A B, Smeeton N C, Talbot I C, Williams G T. Observer variation in the assessment of dysplasia in ulcerative colitis.  Histopathology. 1988;  13 385-397
  • 30 Korelitz B I. Considerations of surveillance, dysplasia, and carcinoma of the colon in the management of ulcerative colitis and Crohn's disease.  Med Clin North Am. 1990;  74 189-199
  • 31 Lennard-Jones J E. Is colonoscopic cancer surveillance in ulcerative colitis essential for every patient?.  Eur J Cancer. 1995;  31 1178-1182
  • 32 Collins R H, Feldman M, Fordtran J S. Colon cancer, dysplasia, and surveillance in patients with ulcerative colitis. A critical review.  N Engl J Med. 1987;  316 1654-1658
  • 33 Axon A T. Colonic cancer surveillance in ulcerative colitis is not essential for every patient?.  Eur J Cancer. 1995;  31 1183-1186
  • 34 Lennard-Jones J E. Cancer risk in ulcerative colitis: surveillance or surgery.  Br J Surg. 1985;  72 S84-86
  • 35 Choi P M, Nugent F W, Schoetz D J, Silverman M L, Haggitt R C. Colonoscopic surveillance reduces mortality from colorectal cancer in ulcerative colitis.  Gastroenterology. 1993;  105 418-424
  • 36 Lofberg R, Brostrom O, Karlen P, Tribukait B, Ost A. Colonoscopic surveillance in long-standing total ulcerative colitis - a 15-year follow-up study.  Gastroenterology. 1990;  99 1021-1031
  • 37 Lashner B A. Recommendations for colorectal cancer screening in ulcerative colitis: a review of research from a single university-based surveillance program.  Am J Gastroenterol. 1992;  87 168-175
  • 38 Fuson J A, Farmer R G, Hawk A, Sullivan B H. Endoscopic surveillance for cancer in chronic ulcerative colitis.  Am J Gastroenterol. 1980;  73 120-126
  • 39 Matiushichev V B, Soldatov A I. High energy laser irradiation in the combined treatment of duodenal ulcer.  Klin Med Mosk. 1994;  72 15-16
  • 40 Martin L F. Stress ulcers are common after aortic surgery. Endoscopic evaluation of prophylactic therapy.  American Surgeon. 1994;  60 169-174
  • 41 Rozen P, Baratz M, Fefer F, Gilat T. Low incidence of significant dyplasia in a successful endoscopic surveillance program of patients with ulcerative colitis (see comments).  Gastroenterology. 1995;  108 1361-1370
  • 42 Jonsson B, Ahsgren L, Andersson L O, Stenling R, Rutegard J. Colorectal cancer surveillance in patients with ulcerative colitis.  British Journal of Surgery. 1994;  81 689-691
  • 43 Lynch D A, Lobo A J, Sobala G M, Dixon M F, Axon A T. Failure of colonoscopic surveillance in ulcerative colitis.  Gut. 1993;  34 1075-1080
  • 44 Ekbom A, Helmick C, Zack M, Adami H O. Increased risk of large-bowel cancer in Crohn's disease with colonic involvement.  Lancet. 1990;  336 357-359
  • 45 Richards M E, Rickert R R, Nance F C. Crohn's disease-associated carcinoma. A poorly recognized complication of inflammatory bowel disease.  Annals of Surgery. 1989;  209 764-773
  • 46 Craft C F, Mendelsohn G, Cooper H S, Yardley J H. Colonic “precancer” in Crohn's disease.  Gastroenterology. 1981;  80 578-584
  • 47 Hamilton S R. Colorectal carcinoma in patients with Crohn's disease.  Gastroenterology. 1985;  89 398-407

1 The European Panel on Appropriateness of Gastrointestinal Endoscopy (EPAGE, Lausanne, Switzerland)

Florian FroehlichMD PD 

Senior Lecturer in Gastroenterology

Policlinique Médicale Universitaire

Rue César-Roux 19

CH-1005 Lausanne

Switzerland

Phone: + 41-32-4662955

Email: florian.froehlich@bluewin.ch