BMJ Open Gastroenterol. 2024 Nov 29;11(1):e001541.doi: 10.1136/bmjgast-2024-001541.

Morris Gordon ¹, Gaurav Bhaskar Nigam ², Vassiliki Sinopoulou ³, Ibrahim Al Bakir ⁴, Adrian C Bateman ⁵, Shahida Din ^6 7, Sunil Dolwani ⁸, Anjan Dhar ^9 10, O D Faiz ^11 12, Bu Hayee ¹³, Chris Healey ¹⁴, Christopher Andrew Lamb ¹⁵, Simon Leedham ², Misha Kabir ¹⁶, Marietta Iacucci ^17 18, Ailsa Hart ¹⁹, A John Morris ²⁰, Marco Novelli ²¹, Tim Raine ²², Matt Rutter ²³, Neil A Shepherd ²⁴, Venkataraman Subramanian ²⁵, Nigel J Trudgill ²⁶, Maggie Vance ¹², Ana Wilson ^12 27, Lydia White ²⁸, Ruth Wakeman ²⁹, James E East ²⁸

Author information

¹BEST unit, University of Central Lancashire, Preston, UK MGordon@uclan.ac.uk.

²University of Oxford Translational Gastroenterology Unit, Oxford, UK.

³University of Central Lancashire, Preston, Lancashire, UK.

⁴Gastroenterology Department, Chelsea and Westminster Hospital, London, UK.

⁵Cellular Pathology, University Hospital Southampton NHS Foundation Trust, Southampton, Hampshire, UK.

⁶Gastroenterology, NHS Lothian, Edinburgh, UK.

⁷NHS Research Scotland, Clydebank, West Dunbartonshire, UK.

⁸Gastroenterology, Cardiff and Vale NHS Trust, Cardiff, UK.

⁹Gastroenterology, County Durham and Darlington NHS Foundation Trust, Darlington, UK.

¹⁰School of Health and Life Sciences, Teesside University, Middlesbrough, UK.

¹¹Department of Surgery and Cancer or Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK.

¹²St Mark's Hospital and Academic Institute, London, London, UK.

¹³King's College Hospital NHS Foundation Trust, London, UK.

¹⁴Gastroenterology, Airedale NHS Foundation Trust, Keighley, UK.

¹⁵Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK.

¹⁶University College London, London, UK.

¹⁷University College Cork, Cork, Cork, Ireland.

¹⁸University of Birmingham, Birmingham, UK.

¹⁹St Mark's Hospital, London, UK.

²⁰Gastroenterology, Glasgow Royal Infirmary, Glasgow, UK.

²¹Department of Histopathology, University College London, London, UK.

²²Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK.

²³University Hospital of North Tees, Stockton-on-Tees, UK.

²⁴Gloucestershire Hospitals NHS Foundation Trust, Cheltenham, Gloucestershire, UK.

²⁵Gastroenterology, Leeds Teaching Hospitals NHS Trust, Leeds, UK.

²⁶Department of Gastroenterology, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, UK.

²⁷Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK.

²⁸Nuffield Department of Medicine, University of Oxford Translational Gastroenterology Unit, Oxford, UK.

²⁹Crohn's & Colitis UK, Hatfield, Hertfordshire, UK.

Abstract

Introduction: The evolving landscape of inflammatory bowel disease (IBD) necessitates refining colonoscopic surveillance guidelines. This study outlines methodology adopted by the British Society of Gastroenterology (BSG) Guideline Development Group (GDG) for updating IBD colorectal surveillance guidelines.

Methods and analysis: The 'Grading of Recommendations, Assessment, Development and Evaluation' (GRADE) approach, as outlined in the GRADE handbook, was employed. Thematic questions were formulated using either the 'patient, intervention, comparison and outcome' format or the 'current state of knowledge, area of interest, potential impact and suggestions from experts in the field' format. The evidence review process included systematic reviews assessed using appropriate appraisal tools. An extensive list of potential outcomes was compiled from literature and expert consultations and then ranked by GDG members. The top outcomes were identified for evidence synthesis in three key areas: utility of surveillance in IBD, quality of bowel preparation and use of advanced imaging techniques in colonoscopy for IBD. Risk thresholding exercises determined specific risk levels for different surveillance strategies and intervals. This approach enabled the GDG to establish precise thresholds for interventions based on relative and absolute risk assessments, directly informing the stratification of surveillance recommendations. Significance of effect sizes (small, moderate, large) will guide the final GRADE assessment of the evidence.

Ethics and dissemination: Ethics approval is not applicable. By integrating clinical expertise, patient experiences and innovative methodologies like risk thresholding, we aim to deliver actionable recommendations for IBD colorectal surveillance. This protocol, complementing the main guidelines, offers GDGs, clinical trialists and practitioners a framework to inform future research and enhance patient care and outcomes.