Pit pattern analysis with high-definition chromoendoscopy and narrow-band imaging for optical diagnosis of dysplasia in patients with ulcerative colitis

Bisschops, Raf; Bessissow, Talat; Dekker, Evelien; East, James E.; Para-Blanco, Adolfo; Ragunath, Krish; Bhandari, Pradeep; Rutter, Matt; Schoon, Erik J.; Wilson, Ana; John, Jestinah Mahachie; Steen, Kristel Van; Baert, Filip; Ferrante, Marc

doi:10.1016/j.gie.2017.09.024

Cited by 47 publications

(47 citation statements)

References 22 publications

(42 reference statements)

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“…4). 15 The reasons for the lack of classifiable patterns are unclear, but this deficiency may reflect the continuing inflammation and the higher incidence of poorly differentiated and signet ring cancers 16 diagnosed in colonic IBD.…”

Section: Flat Lesion Without Protrusion Above the Mucosamentioning

confidence: 99%

Endoscopic submucosal dissection for nonpolypoid colorectal dysplasia in patients with inflammatory bowel disease: in medias res

Soetikno

East

Suzuki

et al. 2018

Gastrointestinal Endoscopy

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Section: Flat Lesion Without Protrusion Above the Mucosamentioning

confidence: 99%

Endoscopic submucosal dissection for nonpolypoid colorectal dysplasia in patients with inflammatory bowel disease: in medias res

Soetikno

East

Suzuki

et al. 2018

Gastrointestinal Endoscopy

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“…The classification commonly used to characterize visible lesions in IBD is the Kudo's classification [63]. Recent meta-analyses have suggested specific features (Kudo pit pattern type I or II, chromoendoscopy, or NBI) can be effective in enhancing the negative predictive value to 88 % -94 % [157,158]. Subsequent data using high definition dye-based chromoendoscopy and endoscopic trimodal imaging support this [159,160].…”

Section: Recommendationmentioning

confidence: 99%

Curriculum for optical diagnosis training in Europe: European Society of Gastrointestinal Endoscopy (ESGE) Position Statement

et al. 2020

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Main RecommendationsThis manuscript represents an official Position Statement of the European Society of Gastrointestinal Endoscopy (ESGE) aiming to guide general gastroenterologists to develop and maintain skills in optical diagnosis during endoscopy. In general, this requires additional training beyond the core curriculum currently provided in each country. In this context, ESGE have developed a European core curriculum for optical diagnosis practice across Europe for high quality optical diagnosis training. 1 ESGE suggests that every endoscopist should have achieved general competence in upper and/or lower gastrointestinal (UGI/LGI) endoscopy before commencing training in optical diagnosis of the UGI/LGI tract, meaning personal experience of at least 300 UGI and/or 300 LGI endoscopies and meeting the ESGE quality measures for UGI/LGI endoscopy. ESGE suggests that every endoscopist should be able and competent to perform UGI/LGI endoscopy with high definition white light combined with virtual and/or dye-based chromoendoscopy before commencing training in optical diagnosis. 2 ESGE suggests competency in optical diagnosis can be learned by attending a validated optical diagnosis training course based on a validated classification, and self-learning with a minimum number of lesions. If no validated training course is available, optical diagnosis can only be learned by attending a non-validated onsite training course and self-learning with a minimum number of lesions. 3 ESGE suggests endoscopists are competent in optical diagnosis after meeting the pre-adoption and learning criteria, and meeting competence thresholds by assessing a minimum number of lesions prospectively during real-time endoscopy. ESGE suggests ongoing in vivo practice by endoscopists to maintain competence in optical diagnosis. If a competent endoscopist does not perform in vivo optical diagnosis on a regular basis, ESGE suggests repeating the learning and competence phases to maintain competence.Key areas of interest were optical diagnosis training in Barrett’s esophagus, esophageal squamous cell carcinoma, early gastric cancer, diminutive colorectal lesions, early colorectal cancer, and neoplasia in inflammatory bowel disease. Condition-specific recommendations are provided in the main document.

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“… 12 Recently, Bisschops et al . 11 used lesions retrieved from a randomized controlled trial comparing high-definition CE with NBI for the surveillance of colitis-associated dysplasia, and analyzed the diagnostic performance of pit patterns for predicting dysplasia. Carefully selected images of clearly visible lesions with visible pits were used in their study, and the sensitivity, specificity, and accuracy of neoplastic pit patterns for predicting dysplasia were 77%, 69%, and 72%, respectively.…”

Section: Discussionmentioning

confidence: 99%

“…In the earliest study evaluating the role of CE for detecting dysplasia in UC, 6 Kudo pit patterns showed a 92% accuracy for differentiating between neoplastic and non-neoplastic lesions. However, in subsequent studies, Kudo pit patterns showed only 72% to 73% diagnostic accuracy for differentiating between neoplastic and non-neoplastic lesions in the colitis patients, 11 , 12 which would be inappropriate to use as indicators for dysplasia in the clinical practice. The relative inaccuracy of pit patterns for predicting colitis-associated dysplasia may be associated with diffuse and long-standing inflammatory changes in both the dysplasia and surrounding mucosa.…”

Section: Introductionmentioning

confidence: 99%

Endoscopic Diagnosis of Nonpedunculated Dysplasia during Surveillance of Ulcerative Colitis: A Survey-Based Multinational Study

et al. 2020

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Background/Aims: Endoscopic diagnosis of dysplasia or colitic cancer in patients with ulcerative colitis (UC) is more challenging than that of colorectal neoplasia in non-colitic patients. We aimed to evaluate the accuracy of the endoscopic diagnosis of "nonpedunculated" dysplasia or colitic cancer in UC patients. Methods: Ten endoscopists from four countries were surveyed using photographs of 61 histologically confirmed dysplastic or non-dysplastic lesions retrieved from the UC registry database of Asan Medical Center. The participants provided their assessment based on the given photographs and their intention to perform biopsy. Results:The overall diagnostic performance of the 10 participants is summarized as follows: sensitivity of 88.2% (95% confidence interval [CI], 84.3% to 91.5%), specificity of 34.8% (95% CI, 29.1% to 40.8%), positive predictive value of 63.0% (95% CI, 60.8% to 65.2%), negative predictive value of 70.2% (95% CI, 62.7% to 76.6%), and accuracy of 64.6% (95% CI, 60.7% to 68.4%). The interobserver agreement on the intention to perform a biopsy was poor (Fleiss kappa=0.169). Of the three endoscopic characteristics of the lesions, including ulceration, distinctness of the borders, and pit patterns, only neoplastic pit patterns were significantly predictive of dysplasia (odds ratio, 3.710; 95% CI, 2.001 to 6.881). The diagnostic sensitivity and specificity of neoplastic pit patterns were 68.2% (95% CI, 63.0% to 73.2%) and 63.3% (95% CI, 57.3% to 69.1%), respectively. Conclusions: Diagnostic per-formance based on the endoscopist's intention to perform a biopsy for nonpedunculated potentially dysplastic lesions in UC patients was suboptimal according to this survey-based study. (Gut Liver,

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Pit pattern analysis with high-definition chromoendoscopy and narrow-band imaging for optical diagnosis of dysplasia in patients with ulcerative colitis

Cited by 47 publications

References 22 publications

Endoscopic submucosal dissection for nonpolypoid colorectal dysplasia in patients with inflammatory bowel disease: in medias res

Endoscopic submucosal dissection for nonpolypoid colorectal dysplasia in patients with inflammatory bowel disease: in medias res

Curriculum for optical diagnosis training in Europe: European Society of Gastrointestinal Endoscopy (ESGE) Position Statement

Endoscopic Diagnosis of Nonpedunculated Dysplasia during Surveillance of Ulcerative Colitis: A Survey-Based Multinational Study

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