Driffa Moussata1, Matthieu Allez2, Dominique Cazals-Hatem3, Xavier Treton4, David Laharie5, Jean-Marie Reimund6, Philippe Bertheau7, Arnaud Bourreille8, Anne Lavergne-Slove9, Hedia Brixi10, Julien Branche11, Jean-Marc Gornet2, Carmen Stefanescu4, Jacques Moreau12, Philippe Marteau13, Anne-Laure Pelletier14, Franck Carbonnel15, Philippe Seksik16, Marion Simon17, Jean-François Fléjou18, Jean-Fréderic Colombel19, Anne-Laure Charlois1, Xavier Roblin20, Stéphane Nancey1, Yoram Bouhnik4, Françoise Berger21, Bernard Flourié1. 1. Gastroenterology Department, Lyon Sud Hospital, Pierre Bénite, France. 2. Gastroenterology Department, Saint-Louis Hospital, Paris, France. 3. Pathology Department, Beaujon Hospital, Clichy, France. 4. Gastroenterology Department, Beaujon Hospital, Clichy, France. 5. Gastroenterology Department, Bordeaux Hospital, Pessac, France. 6. Gastroenterology Department, INSERM U1113 and Hautepierre Hospital, Strasbourg, France. 7. Pathology Department, Saint-Louis Hospital, Paris, France. 8. Gastroenterology Department, CIC Inserm 1413, Nantes University, Nantes, France. 9. Pathology Department, Lariboisière Hospital, Paris, France. 10. Hepato-Gastroenterology Department, Robert Debre University Hospital, Reims, France. 11. Gastroenterology Department, Claude Huriez Hospital, Lille, France. 12. Gastroenterology Department, Rangueil Hospital, Toulouse, France. 13. Hepatology Department, Saint-Antoine Hospital, Paris, France. 14. Gastroenterology Department, Bichat Claude Bernard Hospital, Paris, France. 15. Gastroenterology Department, Bicêtre Hospital, Le Kremlin-Bicêtre, France. 16. Gastroenterology Department, Saint-Antoine Hospital, Paris, France. 17. Hepato-Gastroenterology Department, Institut Mutualiste Montsouris, Paris, France. 18. Pathology Department, Saint-Antoine Hospital, Paris, France. 19. Gastroenterology Department, Icahn School of Medicine Mount Sinai, New York, USA. 20. Gastroenterology Department, University Hospital, Saint Etienne, France. 21. Pathology Department, Lyon Sud Hospital, Pierre Bénite, France.
Abstract
BACKGROUND:Colonoscopy with pan-chromoendoscopy (CE) is superior to standard colonoscopy in detecting neoplasia in patients with IBD. Performing random biopsies in unsuspicious mucosa after CE remains controversial. METHODS:Consecutive patients with IBD who underwentsurveillance colonoscopy using CE were prospectively included. The standardised procedure used CE, performed targeted biopsies or endoscopic resection on suspicious lesions and then quadrant random biopsies every 10 cm. A panel of five expert pathologists reviewed histological slides with dysplasia. Logistic regression model was used to evidence the factors associated with neoplasia in any or in random biopsies. RESULTS: 1000 colonoscopes were performed in 1000 patients (495 UC, 505 Crohn's colitis). In 82 patients, neoplasia was detected from targeted biopsies or removed lesions, and among them dysplasia was detected also by random biopsies in 7 patients. Importantly, in 12 additional patients dysplasia was only detected by random biopsies. Overall, 140 neoplastic sites were found in 94 patients, 112 (80%) from targeted biopsies or removed lesions and 28 (20%) by random biopsies. The yield of neoplasia by random biopsies only was 0.2% per-biopsy (68/31 865), 1.2% per-colonoscopy (12/1000) but 12.8% per-patient with neoplasia (12/94). Dysplasia detected by random biopsies was associated with a personal history of neoplasia, a tubular appearing colon and the presence of primary sclerosing cholangitis (PSC). CONCLUSIONS: Despite their low yield, random biopsies should be performed in association with CE in patients with IBD with a personal history of neoplasia, concomitant PSC or a tubular colon during colonoscopy. TRIAL REGISTRATION NUMBER: IRB 001508, Paris 7 University. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.
RCT Entities:
BACKGROUND: Colonoscopy with pan-chromoendoscopy (CE) is superior to standard colonoscopy in detecting neoplasia in patients with IBD. Performing random biopsies in unsuspicious mucosa after CE remains controversial. METHODS: Consecutive patients with IBD who underwent surveillance colonoscopy using CE were prospectively included. The standardised procedure used CE, performed targeted biopsies or endoscopic resection on suspicious lesions and then quadrant random biopsies every 10 cm. A panel of five expert pathologists reviewed histological slides with dysplasia. Logistic regression model was used to evidence the factors associated with neoplasia in any or in random biopsies. RESULTS: 1000 colonoscopes were performed in 1000 patients (495 UC, 505 Crohn's colitis). In 82 patients, neoplasia was detected from targeted biopsies or removed lesions, and among them dysplasia was detected also by random biopsies in 7 patients. Importantly, in 12 additional patientsdysplasia was only detected by random biopsies. Overall, 140 neoplastic sites were found in 94 patients, 112 (80%) from targeted biopsies or removed lesions and 28 (20%) by random biopsies. The yield of neoplasia by random biopsies only was 0.2% per-biopsy (68/31 865), 1.2% per-colonoscopy (12/1000) but 12.8% per-patient with neoplasia (12/94). Dysplasia detected by random biopsies was associated with a personal history of neoplasia, a tubular appearing colon and the presence of primary sclerosing cholangitis (PSC). CONCLUSIONS: Despite their low yield, random biopsies should be performed in association with CE in patients with IBD with a personal history of neoplasia, concomitant PSC or a tubular colon during colonoscopy. TRIAL REGISTRATION NUMBER: IRB 001508, Paris 7 University. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.
Authors: Gary R Lichtenstein; Edward V Loftus; Kim L Isaacs; Miguel D Regueiro; Lauren B Gerson; Bruce E Sands Journal: Am J Gastroenterol Date: 2018-03-27 Impact factor: 10.864
Authors: Sofia Saraiva; Isadora Rosa; Joana Moleiro; João Pereira da Silva; Ricardo Fonseca; António Dias Pereira Journal: GE Port J Gastroenterol Date: 2020-10-19