Advanced neoplasia detection using chromoendoscopy and white light colonoscopy for surveillance in patients with inflammatory bowel disease

Abstract

Background/Aims: Chromoendoscopy (CE) has been shown to be superior to white light endoscopy (WLE) for neoplasia detection in inflammatory bowel disease (IBD). We aimed to compare the yield of CE and WLE for the detection of overall neoplasia and advanced neoplasia in IBD. Methods: Patients who underwent surveillance colonoscopy from 1999 to 2017 were identified from our IBD database. CE procedures were compared with their respective WLE controls in a paired comparison, and frequency of all neoplasia, advanced neoplasia, and serrated neoplasia was assessed for both targeted and random biopsies.Results: A total of 290 procedures performed in 98 individuals were identified with a median follow-up 4 years (median 3 colonoscopies/patient). CE and WLE were performed in 159 and 131 episodes, respectively. CE detected neoplasia in 40.9% of colonoscopies versus 23.7% with WLE (<i>P</i>= 0.002). In addition, CE detected more advanced neoplasia (18.2% vs. 6.1%, <i>P</i>= 0.002) and serrated lesions (14.5% vs. 6.1%, <i>P</i>= 0.022). Significantly fewer samples were obtained per procedure with CE (14.9 ± 9.7 vs. 20.9 ± 11.1, <i>P</i>< 0.001). Cancer was diagnosed in 2 cases.Conclusions: CE has a higher detection rate than WLE for advanced neoplasia and serrated lesions in patients with IBD under surveillance. Further prospective studies evaluating the impact of CE on decreasing the risk of interval cancer and colectomy in IBD patients are warranted.

Colorectal Cancer Surveillance in Patients with Inflammatory Bowel Diseases: Chromoendoscopy or Non-Chromoendoscopy, That Is the Question

“…DCE showed a higher detection of dysplasia compared to HD-WLE (17 vs. 7; p = 0.032) [40]. Even in a retrospective study by Kim et al DCE performed better than HD-WLE in dysplasia detection [41]. In this study, a paired comparison between 159 DCE and 131 WLE controls (of which 124 HD-WLE and 7 SD-WLE) was performed.…”

“…The overall neoplasia detection rate was 40.9% in the DCE group and 23.7% in WLE (p = 0.002). Interestingly, these results did not change significantly even after excluding the 7 SD-WLE procedures [41]. Similarly, another retrospective study conducted by Sekra et al [42] showed that DCE with targeted biopsies was associated with a higher nonpolypoid dysplasia detection rate compared to HD-WLE.…”

“…Additionally, in recent years, two meta-analysis and three network meta-analysis agreed that DCE may add a benefit over WLE only in the setting of SD but not of HD systems, confirming the necessity of the latter technology when performing surveillance colonoscopy [21,63,64,68,69]. However, other recent studies have conversely shown an incremental yield of DCE over HD-WLE [39][40][41][42][43][44]. Therefore, discontinuing DCE during surveillance should be carefully evaluated and further RCT are needed.…”

Current Elective Surgical Treatment of Inflammatory Bowel Disease

“…Strictureplasty should not be used in large bowel because the risk of malignization. Chronic inflammation is a risk factor for colon cancer and dysplasia is considered to be the precursor of most colorectal cancer in IBD patients [43].…”

Underutilization of societal guidelines: occasional or widespread?

“…We screen and variably surveille for Barrett’s esophagus and undertake or refer patients to experienced colleagues for endoscopic mucosal resection or endoscopic submucosal dissection with finding of high-grade dysplasia and high-risk patients with superficial malignancy 22 23 24 25 26 . We recognize that chromo-endoscopy finds more dysplasia with fewer biopsies then white light endoscopy with or without the ability to magnify the image or filter the wavelength, but without formal societal guidelines, it is the minority of endoscopists who utilize it in screening patients with inflammatory bowel disease 27 28 29 . However, there are guidelines to screen for gastric malignancy 30 , to perform and interpret capsule endoscopy 31 appropriately, and about the appropriate application of endoscopic ultrasound 32 , as well as dozens of other endoscopic procedures.…”