Mistakes in colonoscopic surveillance in IBD and how to avoid them

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Mistakes in colonoscopic surveillance in IBD and how to avoid them

Matt Rutter

Summary

AI Generated

The diagnosis and management of colorectal cancer in patients with inflammatory bowel disease presents challenges and controversies, with mistakes in colitis surveillance potentially leading to unnecessary surgery or avoidably high cancer risk.

Optimal management requires thorough knowledge of both IBD and colorectal cancer, including the benefits and limitations of colonoscopic surveillance
Key components of optimal management include careful IBD control, high-quality colonoscopy, robust surveillance booking mechanisms, empathic patient education, and excellent multidisciplinary team communication
Errors in managing patients undergoing colitis surveillance can result in patients being subjected to unnecessary life-changing surgery or exposed to an avoidably high lifetime risk of cancer
The material discusses common mistakes in colitis surveillance management, drawing on evidence-based approaches and the author's more than 20 years of personal experience in the field

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This summary was generated by an AI large language model based on the content transcript. It is for informational purposes only and should not be considered a substitute for clinical judgment. Always rely on your professional expertise and the full clinical context when making clinical decisions.

References

Mistakes

References

Mistake 1 Mistake 2 Mistake 3 Mistake 4 Mistake 5 Mistake 6 Mistake 7 Mistake 8

Soderlund S, Granath F, Brostrom O, et al. Inflammatory bowel disease confers a lower risk of colorectal cancer to females than to males. Gastroenterology 2010; 138: 1697–1703. [Link]

Jess T, Rungoe C and Peyrin-Biroulet L. Risk of colorectal cancer in patients with ulcerative colitis: a meta-analysis of population-based cohort studies. Clin Gastroenterol Hepatol 2012; 638: 639–645. [Link]

Lutgens MW, van Oijen MG, van der Heijden GJ, et al. Declining risk of colorectal cancer in inflammatory bowel disease: an updated meta-analysis of population-based cohort studies. Inflamm Bowel Dis 2013; 19: 789–799. [Link]

Herrinton LJ, Liu L, Levin TR, et al. Incidence and mortality of colorectal adenocarcinoma in persons with inflammatory bowel disease from 1998 to 2010. Gastroenterology 2012; 143: 382–389. [Link]

Burr NE, Derbyshire E, Taylor J, et al. Variation in post-colonoscopy colorectal cancer across colonoscopy providers in English National Health Service: population based cohort study. BMJ 2019; 367: l6090. [Link]

Shah SC, ten Hove JR, Castaneda D, et al. High risk of advanced colorectal neoplasia in patients with primary sclerosing cholangitis associated with inflammatory bowel disease. Clin Gastroenterol Hepatol 2018; 16: 1106–1113.e3. [Link]

Jess T, Simonsen J, Jorgensen KT, et al. Decreasing risk of colorectal cancer in patients with inflammatory bowel disease over 30 years. Gastroenterology 2012; 143: 375–381.e1. [Link]

Rutter M, Saunders B, Wilkinson K, et al. Severity of inflammation is a risk factor for colorectal neoplasia in ulcerative colitis. Gastroenterology 2004; 126: 451–459. [Link]

Rutter MD, Saunders BP, Wilkinson KH, et al. Cancer surveillance in longstanding ulcerative colitis: endoscopic appearances help predict cancer risk. Gut 2004; 53: 1813–1816. [Link]

10.

Ekbom A, Helmick C, Zack M, et al. Ulcerative colitis and colorectal cancer. A population-based study. N Engl J Med 1990; 323: 1228–1233. [Link]

11.

Annese V, Daperno M, Rutter MD, et al. European evidence based consensus for endoscopy in inflammatory bowel disease. J Crohns Colitis 2013; 7: 982–1018. [Link]

12.

Cairns SR, Scholefield JH, Steele RJ, et al. Guidelines for colorectal cancer screening and surveillance in moderate and high risk groups (update from 2002). Gut 2010; 59: 666–689. [Link]

13.

Laine L, Kaltenbach T, Barkun A, et al. SCENIC international consensus statement on surveillance and management of dysplasia in inflammatory bowel disease. Gastroenterology 2015; 148: 639–651.e28. [Link]

14.

Imperatore N, Castiglione F, Testa A, et al. Augmented endoscopy for surveillance of colonic inflammatory bowel disease: systematic review with network meta-analysis. J Crohns Colitis 2019; 13: 714–724. [Link]

15.

Travis SP, Schnell D, Krzeski P, et al. Developing an instrument to assess the endoscopic severity of ulcerative colitis: the Ulcerative Colitis Endoscopic Index of Severity (UCEIS). Gut 2012; 61: 535–542. [Link]

16.

The Paris endoscopic classification of superficial neoplastic lesions: esophagus, stomach, and colon: November 30 to December 1, 2002. Gastrointest Endosc 2003; 58: S3–S43. [Link]

Abstract

The diagnosis and management of colorectal cancer in patients who have inflammatory bowel disease is fraught with challenges and the subject is not without controversy. Optimal management requires a thorough knowledge of both diseases as well as the benefits and limitations of colonoscopic surveillance, careful IBD control, high-quality colonoscopy, robust surveillance booking mechanisms, empathic patient education and excellent communication across the multidisciplinary team looking after the patient. Make a mistake and your patient might be subjected to unnecessary life-changing surgery or exposed to an avoidably high lifetime risk of cancer. Here I discuss the mistakes that are often made when managing patients undergoing colitis surveillance. The discussion is evidence based, but where evidence is lacking, the discussion is based on my personal experience of more than 20 years in the field.

Topics

Digestive Oncology Endoscopy IBD

Citation

Rutter MD. Mistakes in colonoscopic surveillance in IBD and how to avoid them. UEG Education 2021; 21: 26–28

Published

2021

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The European Multidisciplinary Evidence-Based Guideline on Pancreatic Cancer: Methodological Protocol

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UEG Standards and Guidelines

New

Clinical Practice Guideline

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The European Multidisciplinary Evidence-Based Guideline on Pancreatic Cancer: Methodological Protocol

Laura Leeuwenburgh

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Guideline

ABSTRACT

Background

Pancreatic cancer remains one of the most lethal cancers despite extensive efforts and research conducted over the past decades. To effectuate groundbreaking improvements in pancreatic cancer treatment, interdisciplinary and international collaboration is essential. Evidence-based guidelines, including state-of-the-art evidence and expert opinion, are crucial to guide medical specialists, researchers, and patients, especially on issues where consensus is still lacking. This article describes the methodological protocol for the development of the European Multidisciplinary Evidence-Based Guideline on Pancreatic Cancer. The guideline aims to identify current knowledge gaps on pancreatic cancer management, develop questions based on these knowledge gaps, and answer these questions with evidence-based recommendations supplemented, when evidence is lacking, with expert advice for treatment and future research.

Methods

This guideline development protocol is developed according to the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) methodology. The process is structured into six stages: First, 13 theme-based multidisciplinary working groups are established, comprising representatives from 30 European medical and patient societies. Second, these working groups identify the most relevant current knowledge gaps on pancreatic cancer within their theme and formulate key questions. Third, the available evidence to answer these key questions is obtained through systematic reviews and the certainty of evidence is assessed using the GRADE approach. Fourth, recommendations are developed based on the available evidence. Fifth, all participants reach consensus on the recommendations through a modified Delphi process. Sixth, the recommendations are discussed during an open conference, including an external validation committee.

Discussion

This methodological protocol of the European Multidisciplinary Evidence-Based Guideline on Pancreatic Cancer is designed to identify key knowledge gaps across 13 themes and formulate evidence-based recommendations. This guideline initiative unites 30 European medical and patient societies for pancreatic cancer.

Summary

Methodological protocol of an international multi-disciplinary guideline involving 30 European medical and patient societies.
This protocol highlights the six stages of the guideline development process, adhering to the key principles of the GRADE methodology, and thereby aims to maximise transparency and methodological quality.
With addressing knowledge gaps, this guideline will uncover areas with limited evidence. A priority rating for research needs, based on a survey, will be established, highlighting areas where future research is most warranted.

Guideline

Clinical Practice Guideline

Topics

Pancreas

Citation

Clinical and Public Health Guidelines 3 (2026)

Published

2026

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UEG Mistakes In Articles

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Mistakes in hepatitis C and how to avoid them

Ana Catarina Garcia, Gonçalo Alexandrino

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References

Mistakes

References

Mistake 1 Mistake 2 Mistake 3 Mistake 4 Mistake 5 Mistake 6 Mistake 7 Mistake 8

Soderlund S, Granath F, Brostrom O, et al. Inflammatory bowel disease confers a lower risk of colorectal cancer to females than to males. Gastroenterology 2010; 138: 1697–1703. [Link]

Herrinton LJ, Liu L, Levin TR, et al. Incidence and mortality of colorectal adenocarcinoma in persons with inflammatory bowel disease from 1998 to 2010. Gastroenterology 2012; 143: 382–389. [Link]

Jess T, Simonsen J, Jorgensen KT, et al. Decreasing risk of colorectal cancer in patients with inflammatory bowel disease over 30 years. Gastroenterology 2012; 143: 375–381.e1. [Link]

Rutter M, Saunders B, Wilkinson K, et al. Severity of inflammation is a risk factor for colorectal neoplasia in ulcerative colitis. Gastroenterology 2004; 126: 451–459. [Link]

Rutter MD, Saunders BP, Wilkinson KH, et al. Cancer surveillance in longstanding ulcerative colitis: endoscopic appearances help predict cancer risk. Gut 2004; 53: 1813–1816. [Link]

10.

Ekbom A, Helmick C, Zack M, et al. Ulcerative colitis and colorectal cancer. A population-based study. N Engl J Med 1990; 323: 1228–1233. [Link]

11.

Annese V, Daperno M, Rutter MD, et al. European evidence based consensus for endoscopy in inflammatory bowel disease. J Crohns Colitis 2013; 7: 982–1018. [Link]

12.

Cairns SR, Scholefield JH, Steele RJ, et al. Guidelines for colorectal cancer screening and surveillance in moderate and high risk groups (update from 2002). Gut 2010; 59: 666–689. [Link]

13.

14.

15.

16.

The Paris endoscopic classification of superficial neoplastic lesions: esophagus, stomach, and colon: November 30 to December 1, 2002. Gastrointest Endosc 2003; 58: S3–S43. [Link]

Abstract

Hepatitis C virus (HCV) infection remains an important global health concern. It is estimated that there are approximately 50 million people infected with HCV globally, with around 1 million new infections each year and about 242,000 deaths annually attributed to HCV-related complications. Most acute HCV infections (55–85%) become chronic due to the virus’s effective evasion strategies, with spontaneous clearance being rare once chronicity is established. This condition often progresses silently, with many individuals unaware of their infection until advanced liver damage has occurred. If left untreated, HCV can lead to severe complications, including liver cirrhosis and hepatocellular carcinoma (HCC). HCV transmission occurs mainly through percutaneous exposure to infected blood. HCV can also spread from mother to infant (vertical transmission) and, less frequently, via sexual contact.1,2 In recent years, the introduction of oral direct-acting antivirals (DAAs), with remarkable safety and effectiveness profiles, has led to a sustained virological response (SVR) in virtually all (>97%) HCV-infected patients, regardless of HCV genotype or disease stage. However, significant barriers remain, such as issues with diagnosis, access to treatment and awareness of the disease.

Here, we discuss some of the misconceptions in HCV management and provide a practical management approach grounded in evidence and clinical experience.

Topics

Hepatobiliary

Citation

Garcia A.C and Alexandrino G. Mistakes in hepatits C and how to avoid them. UEG Education 2025; 25: 14-17.

Published

2025

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UEG Mistakes In Articles

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Mistakes in acute jaundice and how to avoid them

Spyridon Siakavellas, Georgios Papatheodoridis

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Summary is not available for this content yet.

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References

Mistakes

References

Mistake 1 Mistake 2 Mistake 3 Mistake 4 Mistake 5 Mistake 6 Mistake 7 Mistake 8

Soderlund S, Granath F, Brostrom O, et al. Inflammatory bowel disease confers a lower risk of colorectal cancer to females than to males. Gastroenterology 2010; 138: 1697–1703. [Link]

Herrinton LJ, Liu L, Levin TR, et al. Incidence and mortality of colorectal adenocarcinoma in persons with inflammatory bowel disease from 1998 to 2010. Gastroenterology 2012; 143: 382–389. [Link]

Jess T, Simonsen J, Jorgensen KT, et al. Decreasing risk of colorectal cancer in patients with inflammatory bowel disease over 30 years. Gastroenterology 2012; 143: 375–381.e1. [Link]

Rutter M, Saunders B, Wilkinson K, et al. Severity of inflammation is a risk factor for colorectal neoplasia in ulcerative colitis. Gastroenterology 2004; 126: 451–459. [Link]

Rutter MD, Saunders BP, Wilkinson KH, et al. Cancer surveillance in longstanding ulcerative colitis: endoscopic appearances help predict cancer risk. Gut 2004; 53: 1813–1816. [Link]

10.

Ekbom A, Helmick C, Zack M, et al. Ulcerative colitis and colorectal cancer. A population-based study. N Engl J Med 1990; 323: 1228–1233. [Link]

11.

Annese V, Daperno M, Rutter MD, et al. European evidence based consensus for endoscopy in inflammatory bowel disease. J Crohns Colitis 2013; 7: 982–1018. [Link]

12.

Cairns SR, Scholefield JH, Steele RJ, et al. Guidelines for colorectal cancer screening and surveillance in moderate and high risk groups (update from 2002). Gut 2010; 59: 666–689. [Link]

13.

14.

15.

16.

The Paris endoscopic classification of superficial neoplastic lesions: esophagus, stomach, and colon: November 30 to December 1, 2002. Gastrointest Endosc 2003; 58: S3–S43. [Link]

Abstract

Jaundice can be caused by abnormalities in any of the steps comprising the formation, metabolism and excretion of bilirubin. In addition, these processes may be functioning properly, but jaundice can be seen because of an obstruction of the biliary tree at any point, from its intrahepatic origins to its end at the ampulla of Vater. For this reason, it is clear that numerous conditions can result in jaundice. When faced with a patient presenting with jaundice a reasonable and careful diagnostic approach is, therefore, warranted to elucidate the underlying cause of this sign. Conventional wisdom may be that “jaundice by itself never killed anyone,” but it is imperative to find the cause as soon as possible, as prompt intervention saves lives in many cases.

Topics

Hepatobiliary

Citation

Siakavellas S and Papatheodoridis G. Mistakes in acute jaundice and how to avoid them. UEG Education 2018; 18: 24–26.

Published

2025

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Georgios Papatheodoridis

Mistakes in cases on call and how to avoid them

Marine Camus

Mistakes in acute diverticulitis and how to avoid them

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UEG Mistakes In Articles

Share via Email Share on Facebook Share on X Share on LinkedIn Share on Bluesky

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Mistakes in cases on call and how to avoid them

Xavier Dray, Marine Camus

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References

Mistakes

References

Mistake 1 Mistake 2 Mistake 3 Mistake 4 Mistake 5 Mistake 6 Mistake 7 Mistake 8

Soderlund S, Granath F, Brostrom O, et al. Inflammatory bowel disease confers a lower risk of colorectal cancer to females than to males. Gastroenterology 2010; 138: 1697–1703. [Link]

Herrinton LJ, Liu L, Levin TR, et al. Incidence and mortality of colorectal adenocarcinoma in persons with inflammatory bowel disease from 1998 to 2010. Gastroenterology 2012; 143: 382–389. [Link]

Jess T, Simonsen J, Jorgensen KT, et al. Decreasing risk of colorectal cancer in patients with inflammatory bowel disease over 30 years. Gastroenterology 2012; 143: 375–381.e1. [Link]

Rutter M, Saunders B, Wilkinson K, et al. Severity of inflammation is a risk factor for colorectal neoplasia in ulcerative colitis. Gastroenterology 2004; 126: 451–459. [Link]

Rutter MD, Saunders BP, Wilkinson KH, et al. Cancer surveillance in longstanding ulcerative colitis: endoscopic appearances help predict cancer risk. Gut 2004; 53: 1813–1816. [Link]

10.

Ekbom A, Helmick C, Zack M, et al. Ulcerative colitis and colorectal cancer. A population-based study. N Engl J Med 1990; 323: 1228–1233. [Link]

11.

Annese V, Daperno M, Rutter MD, et al. European evidence based consensus for endoscopy in inflammatory bowel disease. J Crohns Colitis 2013; 7: 982–1018. [Link]

12.

Cairns SR, Scholefield JH, Steele RJ, et al. Guidelines for colorectal cancer screening and surveillance in moderate and high risk groups (update from 2002). Gut 2010; 59: 666–689. [Link]

13.

14.

15.

16.

The Paris endoscopic classification of superficial neoplastic lesions: esophagus, stomach, and colon: November 30 to December 1, 2002. Gastrointest Endosc 2003; 58: S3–S43. [Link]

Abstract

It is a difficult task and a great responsibility to evaluate and manage patients with acute - and potentially life-threatening - clinical presentations. It is even more complex to achieve high standards of care for cases on call. Indeed, on-call gastroenterologists, hepatologists and endoscopists are faced with a wide and protean range of gastrointestinal, liver and pancreatic emergencies. The decision-making process for cases on call is mainly based on information received over the phone, on medical knowledge and clinical experience, and on the resources available. As the degree of confidence in any information given on call may vary, it is of tremendous importance to note, and to document, with precise timing, what has been communicated by, proposed to, and eventually decided with, multiple caregivers (i.e. nurses, emergency physicians, intensive care physicians, surgeons, radiologists etc.)

Topics

Endoscopy Surgery

Citation

Dray X and Marteau P. Mistakes in cases on call and how to avoid them. UEG Education 2017; 17: 30–32

Published

2024

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UEG Mistakes In Articles

Share via Email Share on Facebook Share on X Share on LinkedIn Share on Bluesky

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Mistakes in acute diverticulitis and how to avoid them

Anna A.W. van Geloven, Simone Rottier, Marja A. Boermeester

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References

Mistakes

References

Mistake 1 Mistake 2 Mistake 3 Mistake 4 Mistake 5 Mistake 6 Mistake 7 Mistake 8

Soderlund S, Granath F, Brostrom O, et al. Inflammatory bowel disease confers a lower risk of colorectal cancer to females than to males. Gastroenterology 2010; 138: 1697–1703. [Link]

Herrinton LJ, Liu L, Levin TR, et al. Incidence and mortality of colorectal adenocarcinoma in persons with inflammatory bowel disease from 1998 to 2010. Gastroenterology 2012; 143: 382–389. [Link]

Jess T, Simonsen J, Jorgensen KT, et al. Decreasing risk of colorectal cancer in patients with inflammatory bowel disease over 30 years. Gastroenterology 2012; 143: 375–381.e1. [Link]

Rutter M, Saunders B, Wilkinson K, et al. Severity of inflammation is a risk factor for colorectal neoplasia in ulcerative colitis. Gastroenterology 2004; 126: 451–459. [Link]

Rutter MD, Saunders BP, Wilkinson KH, et al. Cancer surveillance in longstanding ulcerative colitis: endoscopic appearances help predict cancer risk. Gut 2004; 53: 1813–1816. [Link]

10.

Ekbom A, Helmick C, Zack M, et al. Ulcerative colitis and colorectal cancer. A population-based study. N Engl J Med 1990; 323: 1228–1233. [Link]

11.

Annese V, Daperno M, Rutter MD, et al. European evidence based consensus for endoscopy in inflammatory bowel disease. J Crohns Colitis 2013; 7: 982–1018. [Link]

12.

Cairns SR, Scholefield JH, Steele RJ, et al. Guidelines for colorectal cancer screening and surveillance in moderate and high risk groups (update from 2002). Gut 2010; 59: 666–689. [Link]

13.

14.

15.

16.

The Paris endoscopic classification of superficial neoplastic lesions: esophagus, stomach, and colon: November 30 to December 1, 2002. Gastrointest Endosc 2003; 58: S3–S43. [Link]

Abstract

Acute diverticulitis is an inflammatory complication of diverticulosis and can either be uncomplicated or complicated. Making the distinction between uncomplicated and complicated acute diverticulitis is essential because treatment strategies differ between the two. Here, we discuss 10 mistakes frequently made when managing patients with acute diverticulitis. We focus on using the correct terminology, diagnostic preference and several treatment options, such as omitting or administering antibiotics, radiological interventions and various aspects of surgery. Acute diverticulitis is an important topic because its incidence is rising worldwide and it is becoming a considerable burden on healthcare systems. Most of the discussion included here is evidence-based, supplemented with many years’ combined clinical experience where evidence is lacking.

Topics

Endoscopy Radiology & Imaging Surgery

Citation

Cite this article as: Rottier SJ, et al. Mistakes in acute diverticulitis and how to avoid them. UEG Education 2019; 19: 31–35.

Published

2019

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UEG Podcast Episode

Journal Podcast

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Episode 6: UEG Journal October Spotlight

Mohsan Subhani, Maria Manuela Estevinho

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Abstract

Topics

Endoscopy Hepatobiliary IBD Pancreas

Published

2025

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