E Mooiweer1, A E van der Meulen-de Jong2, C Y Ponsioen3, H H Fidder1, P D Siersema1, E Dekker3, B Oldenburg1. 1. Department of Gastroenterology and Hepatology, University Medical Center Utrecht, Utrecht, The Netherlands. 2. Department of Gastroenterology and Hepatology, Leiden University Medical Center, Leiden, The Netherlands. 3. Department of Gastroenterology and Hepatology, Amsterdam Medical Center, Amsterdam, The Netherlands.
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.
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 CDpatients 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.
Authors: Fiona D M van Schaik; Fiebo J W ten Kate; G Johan A Offerhaus; Marguerite E I Schipper; Frank P Vleggaar; C Janneke van der Woude; Pieter C F Stokkers; Dirk J de Jong; Daan W Hommes; Ad A van Bodegraven; Peter D Siersema; Bas Oldenburg Journal: Inflamm Bowel Dis Date: 2010-09-07 Impact factor: 5.325
Authors: Stuart R Cairns; John H Scholefield; Robert J Steele; Malcolm G Dunlop; Huw J W Thomas; Gareth D Evans; Jayne A Eaden; Matthew D Rutter; Wendy P Atkin; Brian P Saunders; Anneke Lucassen; Paul Jenkins; Peter D Fairclough; Christopher R J Woodhouse Journal: Gut Date: 2010-05 Impact factor: 23.059
Authors: Gauree Gupta Konijeti; Mark G Shrime; Ashwin N Ananthakrishnan; Andrew T Chan Journal: Gastrointest Endosc Date: 2013-11-18 Impact factor: 9.427
Authors: Ralf Kiesslich; Johannes Fritsch; Martin Holtmann; Heinz H Koehler; Manfred Stolte; Stephan Kanzler; Bernhard Nafe; Michael Jung; Peter R Galle; Markus F Neurath Journal: Gastroenterology Date: 2003-04 Impact factor: 22.682
Authors: Frank J C van den Broek; Pieter C F Stokkers; Johannes B Reitsma; Robin P B Boltjes; Cyriel Y Ponsioen; Paul Fockens; Evelien Dekker Journal: Am J Gastroenterol Date: 2011-03-22 Impact factor: 10.864
Authors: Ralf Kiesslich; Martin Goetz; Katharina Lammersdorf; Constantin Schneider; Juergen Burg; Manfred Stolte; Michael Vieth; Bernhard Nafe; Peter R Galle; Markus F Neurath Journal: Gastroenterology Date: 2007-01-31 Impact factor: 22.682
Authors: David T Rubin; Jami A Rothe; Jeremy T Hetzel; Russell D Cohen; Stephen B Hanauer Journal: Gastrointest Endosc Date: 2007-04-23 Impact factor: 9.427
Authors: James F Marion; Jerome D Waye; Daniel H Present; Yuriy Israel; Carol Bodian; Noam Harpaz; Mark Chapman; Steven Itzkowitz; Adam F Steinlauf; Maria T Abreu; Thomas A Ullman; James Aisenberg; Lloyd Mayer Journal: Am J Gastroenterol Date: 2008-09 Impact factor: 10.864