Dr Wadiamu Gashau (IBD)

Dr Wadiamu Gashau – Guts UK/BSG Trainee network Award 2017

Institution: Pennine Acute Hospitals NHS Trust

Title: RISE NoW (Regional IBD Surveillance Endoscopy North West) study: A real world experience of dysplasia and colorectal cancer surveillance in Inflammatory Bowel Disease (IBD)

Project start date: 7th May 2018

Completion date: 6th May 2019

Summary:

Some people with colitis (inflammatory bowel disease (IBD) affecting the large bowel) have a higher risk of developing cancer compared with everyone else. The greatest risk seems linked with changes of the cells in the bowel lining from ongoing inflammation. A routine check with a thin, flexible tube with an internal camera (colonoscope) is recommended 8-10 years after colitis diagnosis to assess bowel cancer risk. Depending on several factors, further checks may be suggested at 1-5 year intervals. This close observation process (surveillance) aims to find early changes in the bowel lining which could lead to cancer.

Current recommended practice involves coloured dye which is sprayed over the inner bowel lining and viewed with advanced colonoscopes showing high quality images. This better highlights changes in the bowel lining which may be early cancer, allowing targeted removal or testing from these areas. This method is not used in all hospitals and it is not clear why. Previously, surveillance was performed by taking bowel wall tissue samples at regular distances along with samples of areas which looked abnormal. However this has been shown to sample less than 1% of the bowel lining and is less accurate at identifying early changes. Yet this is still current practice in many centres.

We would like to map the practice of surveillance in North-West England in an attempt to understand the reasons for not using the currently recommended method. Understanding, enabling and improving current practice will help us provide the best care for our patients.

Specialty trainee doctors in gastroenterology across the North-West of England, supported by a Guts UK (initially Core) grant, are working together to understand surveillance across multiple hospitals within our region and the reasons they may vary. We will be supported by Dr Jimmy K.Limdi (Pennine Acute Hospitals) where some of the information will be gathered.

We plan to ask questions of doctors or nurses carrying out these examinations to develop a picture of surveillance in the region. We would also like to understand reasons for differences in what people do and ask them if there are ways things could be improved. Finally we would like to assess whether varying in practice results in a difference in the rate and number of abnormal cells detected. The project will begin in May 2018 for a period of 12 months. We will report our findings to CORE and present our anonymised findings at national and international meetings to encourage shared learning. We would also aim to publish our findings in a peer reviewed journal.

This project will give us insight into real world practice across our region. By knowing what prevents or encourages best practice, we may be able to share recommendations and assist hospitals in developing better models of care. This in turn will allow us to provide the best standards of surveillance and be a measure of our success.

IBD is the third most likely factor to lead to bowel cancer. Bowel cancer in turn causes the death of up to 15% of people with IBD. Our understanding of changes in cells which line the bowel before cancer develops has improved over the last 10 years. We are now able to detect abnormal cells before cancer occurs. At the same time, improvements in colonoscope imaging and screening techniques have been shown to reduce cancer development in people with IBD. Evidence that this best practice has been adopted by all hospitals is lacking.

The detection and removal of abnormal cells before they turn into cancer has been shown to improve length and quality of life. By ensuring we apply the best methods with endoscopic screening in line with national and international standards, we improve the quality of care we offer all patients who agree to surveillance.

Bowel cancer still accounts for the death of more than 1 in 10 people with longstanding, ongoing colitis. Close observation (surveillance) increases the chances of finding bowel cell changes early and acting before they turn into cancer. GasTRIN NoW are thankful for the BSG-CORE funding which will allow us to understand the differences in surveillance practice within North-West England and the reasons they may exist. We aim use this information to ensure the best method of surveillance is used within our region by sharing and enabling good practice. This will improve the quality of care we offer all patients who agree to surveillance

Dr Wadiamu Gashau