Download PDF
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)

Also available at
    Permissions and Reprints

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
    Article in Thieme ConnectPubMedGoogle Scholar
  • 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
    Article in Thieme ConnectPubMedGoogle Scholar
  • 3 Rutgeerts P, Vantrappen G, Geboes K. Endoscopy in inflammatory bowel disease.  Scand J Gastroenterol Suppl. 1989;  170 12-15
    PubMedGoogle Scholar
  • 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
    PubMedGoogle Scholar
  • 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
    PubMedGoogle Scholar
  • 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
    PubMedGoogle Scholar
  • 7 Podolsky D K. Inflammatory bowel disease (1).  N Engl J Med. 1991;  325 928-937
    PubMedGoogle Scholar
  • 8 Podolsky D K. Inflammatory bowel disease (2) (see comments).  N Engl J Med. 1991;  325 1008-1016
    PubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    PubMedGoogle Scholar
  • 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
    PubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    PubMedGoogle Scholar
  • 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
    PubMedGoogle Scholar
  • 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
    PubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 23 Ransohoff D F. Colon cancer in ulcerative colitis.  Gastroenterology. 1988;  94 1089-1091
    PubMedGoogle Scholar
  • 24 Jain S K, Peppercorn M A. Inflammatory bowel disease and colon cancer - a review.  Digestive Diseases. 1997;  15 243-252
    PubMedGoogle Scholar
  • 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
    PubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    PubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    PubMedGoogle Scholar
  • 31 Lennard-Jones J E. Is colonoscopic cancer surveillance in ulcerative colitis essential for every patient?.  Eur J Cancer. 1995;  31 1178-1182
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 33 Axon A T. Colonic cancer surveillance in ulcerative colitis is not essential for every patient?.  Eur J Cancer. 1995;  31 1183-1186
    CrossrefPubMedGoogle Scholar
  • 34 Lennard-Jones J E. Cancer risk in ulcerative colitis: surveillance or surgery.  Br J Surg. 1985;  72 S84-86
    PubMedGoogle Scholar
  • 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
    PubMedGoogle Scholar
  • 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
    PubMedGoogle Scholar
  • 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
    PubMedGoogle Scholar
  • 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
    PubMedGoogle Scholar
  • 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
    PubMedGoogle Scholar
  • 40 Martin L F. Stress ulcers are common after aortic surgery. Endoscopic evaluation of prophylactic therapy.  American Surgeon. 1994;  60 169-174
    PubMedGoogle Scholar
  • 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
    PubMedGoogle Scholar
  • 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
    PubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    PubMedGoogle Scholar
  • 46 Craft C F, Mendelsohn G, Cooper H S, Yardley J H. Colonic “precancer” in Crohn's disease.  Gastroenterology. 1981;  80 578-584
    PubMedGoogle Scholar
  • 47 Hamilton S R. Colorectal carcinoma in patients with Crohn's disease.  Gastroenterology. 1985;  89 398-407
    PubMedGoogle Scholar

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