AGA medical position statement on the diagnosis and management of colorectal neoplasia in inflammatory bowel disease.

Section of Gastroenterology, Boston Medical Center, Boston University School of Medicine, Boston, Massachusetts, USA.
Gastroenterology (Impact Factor: 16.72). 02/2010; 138(2):738-45. DOI: 10.1053/j.gastro.2009.12.037
Source: PubMed


The AGA Institute Medical Position Panel consisted of the authors of the technical review, a community-based gastroenterologist (Robert P. McCabe, MD, Minnesota Gastroenterology), academic-based gastroenterologists (Themistocles Dassopoulos, MD, James D. Lewis, MD, and Thomas A. Ullman, MD), an insurance provider representative (Tom James III, MD Physician Advisor, Strategic Advisory Group, Humana), a colon and rectal surgeon (Robin McLeod, MD, Mount Sinai Hospital-Canada), a pathologist (Lawrence J. Burgart, MD, Minnesota Gastroenterology), chair of the AGA Institute Clinical Practice and Quality Management Committee (John Allen, MD, Minnesota Gastroenterology), and chair of the Practice Management and Economics Committee (Joel V. Brill, MD, Predictive Health, LLC).

6 Reads
  • Source
    • "In the technical review and position statement published by the AGA, the authors concluded that targeted biopsies using chromoendoscopy performed by endoscopists experienced in this technique is a reasonable screening alternative to the random sampling of colon using standard white light.[6465] "
    [Show abstract] [Hide abstract]
    ABSTRACT: Patients with inflammatory bowel disease (IBD) have an increased risk of developing intestinal cancer. The magnitude of that increased risk as well as how best to mitigate it remain a topic of ongoing investigation in the field. It is important to quantify the risk of colorectal cancer in association with IBD. The reported risk varies widely between studies. This is partly due to the different methodologies used in the studies. Because of the limitations of surveillance strategies based on the detection of dysplasia, advanced endoscopic imaging and techniques involving the detection of alterations in mucosal antigens and genetic abnormalities are being investigated. Development of new biomarkers, predicting future occurrence of colonic neoplasia may lead to more biomarker-based surveillance. There are promising results that may lead to more efficient surveillance in IBD patients and more general acceptance of its use. A multidisciplinary approach, involving in particular endoscopists and pathologists, together with a centralized patient management, could help to optimize treatments and follow-up measures, both of which could help to reduce the IBD-associated cancer risk.
    Saudi Journal of Gastroenterology 03/2014; 20(1):26-38. DOI:10.4103/1319-3767.126314 · 1.12 Impact Factor
  • Source
    • "Interval surveillance is not clearly defined. While the ECCO consensus [27] recommends surveillance colonoscopies every 2-3 years with a decrease in the interval with increasing disease duration, the AGA position statement opens the possibility of a constant colonoscopy interval [46], and the current UK guidelines advocate a surveillance interval tailored according to endoscopic findings and other risk factors, and not influenced by disease duration [26]. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Inflammatory bowel diseases (IBD) are associated to an increased risk of colorectal cancer, which is primarily related to long-standing chronic inflammation. Recognized risk factors are the duration and extent of the disease, severe endoscopic and histological inflammation, primary sclerosing cholangitis, family history of colorectal cancer and in some studies young age at diagnosis. Recent population-based studies have shown that the risk is lower than previously described or even similar to that of the general population, and this could be justified by methodological aspects (hospital-based vs. population-based studies) or by a true decrease in the risk related to a better control of the disease, the use of drugs with chemoprotective effect or the spread of endoscopic surveillance in high-risk patients. Apart from colorectal cancer, patients with IBD are prone to other intestinal neoplasms (lymphoma, small bowel adenocarcinoma, pouch neoplasia and perianal neoplasia). In this article, the magnitude of the risk of intestinal cancer, the risk factors, the natural history of dysplasia and the recommendations of screening and surveillance in IBD are reviewed.
    Annals of Gastroenterology 03/2012; 25(3):193-200.
  • Source
    • "The timing and frequency of colonoscopy depends on extent of disease, comorbidities, and family history, but for most individuals dysplasia screening should begin approximately eight to ten years after diagnosis of IBD and take place yearly [6] [7] [8]. Despite the longstanding consensus that screening "
    [Show abstract] [Hide abstract]
    ABSTRACT: Over the past decade, most quality assurance (QA) efforts in gastroenterology have been aimed at endoscopy. Endoscopic quality improvement was the rational area to begin QA work in gastroenterology due to the relatively acute nature of complications and the high volume of procedures performed. While endoscopy is currently the focus of most quality assurance (QA) measures in gastroenterology, more recent efforts have begun to address clinical gastroenterology practices both in the outpatient and inpatient settings. Clinical outpatient and inpatient gastroenterology is laden with areas where standardization could benefit patient care. While data and experience in clinical gastroenterology QA is relatively limited, it is clear that inconsistent use of guidelines and practice variations in gastroenterology can lead to lower quality care. In this review, we review a variety of areas in clinical gastroenterology where existing guidelines and published data suggest both the need and practicality of active QA measures.
    Best practice & research. Clinical gastroenterology 06/2011; 25(3):387-95. DOI:10.1016/j.bpg.2011.05.007 · 3.48 Impact Factor
Show more