P005 A SURVEY STUDY OF GASTROENTEROLOGISTS’ VIEWS ON DYSPLASIA SURVEILLANCE AND CHROMOENDOSCOPY IN IBD

Background Patients with inflammatory bowel disease (IBD) have an increased risk of colon cancer. Current guidelines are equivocal in their recommendations for chromoendoscopy. The objective of this study is to assess gastroenterologists’ current attitudes and barriers toward chromoendoscopy in IBD. Methods A 23 question survey was distributed to members of the Crohn’s & Colitis Foundation via email. We collected physician characteristics, practice demographics, and data regarding chromoendoscopy use and barriers to chromoendoscopy. Results A total of 57 gastroenterologists from 22 US states [male, n=42 (74%); practicing in an academic university n=44 (77%)] met inclusion criteria. All respondents agree that patients with IBD involving more than 1/3 of the colon have increased risk of colon cancer. Most gastroenterologists agree that patients with extensive UC (100%), left-sided UC (80%), or Crohn’s involving more than 1/3 of the colon (98%) should be in a surveillance protocol, however, 37%, 9%, and 2% also believe that patients with distal ulcerative proctosigmoiditis, ulcerative proctitis, and ileal Crohn’s disease should be in a surveillance protocol respectively. All gastroenterologists perform surveillance in patients without other risk factors within 3 years, however the interval varies: 28% every year, 47% every 2 years, and 25% every 3 years. 61% believe that chromoendoscopy is the preferred method for dysplasia surveillance, but 72% use white light endoscopy most often for surveillance in their clinical practice. Two-thirds (38/57) of gastroenterologists reported ever performing chromoendoscopy. The most common reasons to use chromoendoscopy were history of dysplasia found on random biopsy (89%), history of nonpolypoid dysplasia (76%), or history of primary sclerosing cholangitis (76%). Only 8 gastroenterologists reported using chromoendoscopy for all IBD surveillance. Physicians agree that the top barriers to chromoendoscopy use include longer procedure time (43), lack of standardized training in chromoendoscopy (42), and lack of reimbursement for chromoendoscopy (36); however, most would be likely or very likely to use chromoendoscopy if data showed which patients would benefit most from chromoendoscopy (95%) and if data showed benefits of chromoendoscopy compared to other techniques (93%). Conclusion Most gastroenterologists believe that chromoendoscopy is the ideal method for IBD surveillance, yet white light endoscopy is used most often. Physicians agree that longer procedure times and lack of reimbursement deter chromoendoscopy use, but the majority would be willing to use chromoendoscopy if data showed superiority of chromoendoscopy compared to other techniques and identified patients that would benefit the most.

Minimal change disease associated with balsalazide therapy for ulcerative colitis

Introduction: 5-aminosalicylic acid (5-ASA) compounds have been used in the management of ulcerative colitis for decades. Nephrotoxicity has been previously described in patients treated with 5-ASA compounds and usually manifests as interstitial nephritis, however a few cases of nephrotic syndrome have been reported. Balsalazide is a pro-drug composed of 5-ASA linked to an inert carrier. Case Presentation: Here we report the case of a 74-year-old man with a history of ulcerative proctosigmoiditis treated with balsalazide who presented to our clinic with bilateral lower extremity edema three months after initiation of balsalazide. Laboratory workup showed nephrotic range proteinuria without an apparent secondary etiology. Given worsening proteinuria and renal function despite cessation of balsalazide, the patient underwent renal biopsy that revealed minimal change disease. High dose steroids were started and complete remission of proteinuria was achieved one month into therapy which was slowly tapered over the next five months. Eventual resolution of edema and return of creatinine back to patient’s baseline level was achieved. Conclusion: To our knowledge, this is the first report of nephrotic syndrome manifesting soon after initiation of balsalazide therapy. Our work highlights the importance of maintaining a high clinical suspicion for nephrotoxicity when using balsalazide.