BACKGROUND & AIMS: There is debate over the optimal method for colonoscopic surveillance of patients with inflammatory bowel diseases. Guidelines recommend chromoendoscopy, but the value of chromoendoscopy in high-definition colonoscopy has not been proven. Furthermore, the value of random biopsies is controversial. METHODS: We performed a prospective study of 305 patients with ulcerative colitis or Crohn's colitis referred for surveillance colonoscopy at a university hospital in Sweden, from March 2011 through April 2016. Patients randomly assigned to a group that received high-definition chromoendoscopy with indigo carmine (HD-CE; n [ 152), collection of 32 random biopsies, and targeted biopsies or polypectomies or to a group that received high-definition white light endoscopy (HD-WLE; n [ 153), collection of 32 random biopsies, and targeted biopsies or polypectomies. The primary endpoint was number of patients with dysplastic lesions. RESULTS: Dysplastic lesions were detected in 17 patients with HD-CE and 7 patients with HD-WLE (P [ .032). Dysplasias in random biopsies (n [ 9760) were detected in 9 patients: 6 (3.9%) in the HD-CE group and 3 (2.0%) in the HD-WLE group (P [ .72). Of the 9 patients with dysplasia, 3 patients (33%) had primary sclerosing cholangitis-only 18% of patients (54/305) included in the study had primary sclerosing cholangitis. The number of dysplastic lesions per 10 min of withdrawal time was 0.066 with HD-CE and 0.027 with HD-WLE (P [ .056). CONCLUSIONS: In a randomized trial, we found HD-CE with collection of random biopsies to be superior to HD-WLE with random biopsies for detection of dysplasia per colonoscopy. These results support the use of chromoendoscopy for surveillance of patients with inflammatory bowel diseases. ClinicalTrials.gov no: NCT01505842.
20mm vs. 31mm) in UC group. There were no significant differences about treatment outcome such as R0 resection rate (100% vs.95.4%), curative resection rate (89.5% vs. 90.3%), perforation rate (10.5% vs.7.7%), postoperative bleeding (5.3% vs. 2.2%) and procedure time (67min. vs. 58 min.). Additionally, we evaluated the risk factor of prolonged procedure time over 60min, which indicates technical difficulty in UC patients. Among the clinicopathological characteristics (sex, age, location, macroscopic type, tumor size, extent of disease and duration of disease), tumor size and duration of disease were risk factors affecting to the technical difficulty. Conclusion: Colorectal ESD in patients with UC was feasible, because there were no significant differences according to the rate of adverse events and resectability even when compared with common superficial neoplasms. However, we should treat carefully for patients with larger lesions and long duration of disease due to prolonged procedure time.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.