Chromoendoscopy for Surveillance in IBD
Chromoendoscopy for Surveillance in IBD
Objectives: Randomized trials demonstrated that chromoendoscopy is superior to white light endoscopy with random biopsy sampling (WLE) for the detection of dysplasia in patients with inflammatory bowel disease (IBD). Whether implementing chromoendoscopy can increase the detection of dysplasia in clinical practice is unknown.
Methods: Patients with ulcerative colitis (UC) and Crohn's disease (CD) undergoing colonoscopic surveillance between January 2000 and November 2013 in three referral centers were identified using the patients' medical records. In recent years, the use of high-definition chromoendoscopy was adopted in all three centers using segmental pancolonic spraying of 0.1% methylene blue or 0.3% indigo carmine (chromoendoscopy group). Previously, surveillance was performed employing WLE with random biopsies every 10 cm (WLE group). The percentage of colonoscopies with dysplasia was compared between both groups.
Results: A total of 440 colonoscopies in 401 patients were performed using chromoendoscopy and 1,802 colonoscopies in 772 patients using WLE. Except for a higher number of CD patients with extensive disease and more patients with a first-degree relative with colorectal cancer (CRC) in the chromoendoscopy group, the known risk factors for IBD-associated CRC were comparable between both groups. Dysplasia was detected during 48 surveillance procedures (11%) in the chromoendoscopy group as compared with 189 procedures (10%) in the WLE group (P=0.80). Targeted biopsies yielded 59 dysplastic lesions in the chromoendoscopy group, comparable to the 211 dysplastic lesions detected in the WLE group (P=0.30).
Conclusions: Despite compelling evidence from randomized trials, implementation of chromoendoscopy for IBD surveillance did not increase dysplasia detection compared with WLE with targeted and random biopsies.
Patients with longstanding ulcerative colitis (UC) and Crohn's disease (CD) with colonic involvement have an increased risk of developing colorectal cancer (CRC). Endoscopic surveillance aimed at the detection and treatment of dysplasia and CRC at an early stage is advocated to mitigate this risk, although solid evidence that this strategy is effective is lacking. The detection of neoplasia is challenging, as lesions containing neoplasia are often flat or may not be endoscopically visible at all. Therefore, until recently, surveillance guidelines recommended taking multiple random biopsies throughout the entire colon, although 40 to 50 biopsies are needed to achieve an acceptable accuracy for detecting neoplasia. Moreover, the neoplasia yield of these random biopsies is disappointingly low. In addition, recently published studies show that almost all neoplastic lesions can be identified endoscopically nowadays, casting further doubt on the practice of taking multiple random biopsies for surveillance purposes.
Several randomized trials reported that chromoendoscopy using indigo carmine or methylene blue can increase the neoplasia detection rate substantially compared with white light endoscopy with random biopsy sampling (WLE). These findings have prompted the British Society of Gastroenterology and American Gastroenterological Association to advocate chromoendoscopy as the method of choice for CRC surveillance in their updated guidelines. Whether the broad implementation of chromoendoscopy in clinical practice indeed increases the neoplasia detection rate compared with WLE is currently unknown. The aim of this study was therefore to compare the neoplasia detection rate of colonoscopies performed using chromoendoscopy with procedures performed with WLE.
Abstract and Introduction
Abstract
Objectives: Randomized trials demonstrated that chromoendoscopy is superior to white light endoscopy with random biopsy sampling (WLE) for the detection of dysplasia in patients with inflammatory bowel disease (IBD). Whether implementing chromoendoscopy can increase the detection of dysplasia in clinical practice is unknown.
Methods: Patients with ulcerative colitis (UC) and Crohn's disease (CD) undergoing colonoscopic surveillance between January 2000 and November 2013 in three referral centers were identified using the patients' medical records. In recent years, the use of high-definition chromoendoscopy was adopted in all three centers using segmental pancolonic spraying of 0.1% methylene blue or 0.3% indigo carmine (chromoendoscopy group). Previously, surveillance was performed employing WLE with random biopsies every 10 cm (WLE group). The percentage of colonoscopies with dysplasia was compared between both groups.
Results: A total of 440 colonoscopies in 401 patients were performed using chromoendoscopy and 1,802 colonoscopies in 772 patients using WLE. Except for a higher number of CD patients with extensive disease and more patients with a first-degree relative with colorectal cancer (CRC) in the chromoendoscopy group, the known risk factors for IBD-associated CRC were comparable between both groups. Dysplasia was detected during 48 surveillance procedures (11%) in the chromoendoscopy group as compared with 189 procedures (10%) in the WLE group (P=0.80). Targeted biopsies yielded 59 dysplastic lesions in the chromoendoscopy group, comparable to the 211 dysplastic lesions detected in the WLE group (P=0.30).
Conclusions: Despite compelling evidence from randomized trials, implementation of chromoendoscopy for IBD surveillance did not increase dysplasia detection compared with WLE with targeted and random biopsies.
Introduction
Patients with longstanding ulcerative colitis (UC) and Crohn's disease (CD) with colonic involvement have an increased risk of developing colorectal cancer (CRC). Endoscopic surveillance aimed at the detection and treatment of dysplasia and CRC at an early stage is advocated to mitigate this risk, although solid evidence that this strategy is effective is lacking. The detection of neoplasia is challenging, as lesions containing neoplasia are often flat or may not be endoscopically visible at all. Therefore, until recently, surveillance guidelines recommended taking multiple random biopsies throughout the entire colon, although 40 to 50 biopsies are needed to achieve an acceptable accuracy for detecting neoplasia. Moreover, the neoplasia yield of these random biopsies is disappointingly low. In addition, recently published studies show that almost all neoplastic lesions can be identified endoscopically nowadays, casting further doubt on the practice of taking multiple random biopsies for surveillance purposes.
Several randomized trials reported that chromoendoscopy using indigo carmine or methylene blue can increase the neoplasia detection rate substantially compared with white light endoscopy with random biopsy sampling (WLE). These findings have prompted the British Society of Gastroenterology and American Gastroenterological Association to advocate chromoendoscopy as the method of choice for CRC surveillance in their updated guidelines. Whether the broad implementation of chromoendoscopy in clinical practice indeed increases the neoplasia detection rate compared with WLE is currently unknown. The aim of this study was therefore to compare the neoplasia detection rate of colonoscopies performed using chromoendoscopy with procedures performed with WLE.
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