Endoscopic diagnosis and treatment of ulcerative colitis‐associated neoplasia

Oka, Shiro; Uraoka, Toshio; Watanabe, Kenji; Hata, Keisuke; Kawasaki, Keisuke; Mizuno, Ken‐ichi; Misawa, Masashi; Hosoe, Naoki; Moriyama, Tomohiko; Kawachi, Hiroshi

doi:10.1111/den.13373

Cited by 11 publications

(15 citation statements)

References 13 publications

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“…However, most endoscopists in the present study adopted targeted biopsy with WLE and applied chromoendoscopy only for suspected lesions. Such preference in real-life practice among Japanese specialists has already been reported [ 23 , 24 ], with dysplasia detection rates being almost identical to that reported in studies using chromoendoscopy in Western countries [ 10 ]. Although a couple of controlled studies demonstrated the benefit of panchromoendoscopy a decade ago [ 25 , 26 ], a recent multicenter retrospective study from the Netherlands has demonstrated that chromoendoscopy was less used and did not increase the dysplasia detection rate compared with WLE [ 27 ].…”

Section: Discussionsupporting

confidence: 70%

Long-Term Follow-Up of Targeted Biopsy Yield (LOFTY Study) in Ulcerative Colitis Surveillance Colonoscopy

Hata

Ishihara

Ajioka

et al. 2020

JCM

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We previously performed a randomized controlled trial (RCT) comparing targeted and random biopsy in neoplasia detection in patients with ulcerative colitis (UC), which showed the short-term effectiveness of targeted biopsy with one-time colonoscopy. In this retrospective cohort study, we investigated the long-term effectiveness of targeted biopsy in tertiary care hospitals, using the follow-up data from patients with UC for ≥ 8 years who had enrolled in the initial RCT. The primary outcome was death from colorectal cancer (CRC). Secondary outcomes were advanced neoplasia (CRC or high-grade dysplasia) and colectomy due to neoplasia after the RCT. We compared these outcomes between target and random groups. Data on 195 of the 221 patients (88.2%) enrolled in the previous RCT were collected from 28 institutions between 2008 and 2019. No patients died of CRC in either group, with a median 8.8-year follow-up demonstrating a robustness for targeted biopsy in terms of CRC death prevention. Advanced neoplasia was detected in four and three patients in the target and random groups, respectively. Colectomy was required due to neoplasia in three patients in each group. The chance of developing CRC in patients with a negative colonoscopy was low, and the targeted biopsy appeared effective in this population. Conversely, patients found with low-grade dysplasia at initial RCT have 10-fold higher risk of progression to high-grade dysplasia and/or CRC. Ten extracolonic malignancies were observed during the follow-up, resulting in four deaths. Panchromoendoscopy was used only in 4.6% and targeted biopsy was only performed in 59.1% of colonoscopies. We recommend targeted biopsy rather than > 33 random biopsies in real-world settings under adequate observation by specialists.

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Section: Discussionsupporting

confidence: 70%

Long-Term Follow-Up of Targeted Biopsy Yield (LOFTY Study) in Ulcerative Colitis Surveillance Colonoscopy

Hata

Ishihara

Ajioka

et al. 2020

JCM

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“…Identifying neoplastic lesions using an ordinary endoscope is often difficult; therefore, most endoscopists previously performed blind biopsies. Recently, however, chromoendoscopy, a targeted biopsy under magnifying colonoscopy, has come into use for a more efficient detection of neoplastic lesions [5][6][7][8][9][10]. Due to advances in surveillance colonoscopy techniques and the development of high-definition endoscopes, most UC-associated neoplasias (UCANs) that were previously difficult to identify have become endoscopically detectable, and the frequency of well-circumscribed UCANs has increased [6,11,12].…”

Section: Introductionmentioning

confidence: 99%

“…However, proctocolectomy can sometimes lead to postoperative adverse events and may decrease the patient's quality of life. In contrast, management of endoscopically visible dysplastic lesions is best determined by its endoscopic resectability, if the lesion is well-circumscribed and can be removed safely and completely; recent reports recommend endoscopic resection [9][10][11][12]15].…”

Section: Introductionmentioning

confidence: 99%

Long-Term Outcomes after Endoscopic Submucosal Dissection for Ulcerative Colitis-Associated Dysplasia

et al. 2019

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Introduction: The Surveillance for Colorectal Endoscopic Neoplasia Detection and Management in Inflammatory Bowel Disease Patients: International Consensus Recommendations guidelines recommend surveillance colonoscopy instead of colectomy after the complete removal of “endoscopically resectable” dysplastic lesions in ulcerative colitis (UC). There are no studies on long-term outcomes of endoscopic submucosal dissection (ESD) for UC-associated neoplasia (UCAN). We aimed to evaluate the clinical outcomes of ESD for UC-associated dysplasia (UCAD) during long-term follow-up. Methods: We retrospectively enrolled 17 consecutive UC patients with 22 UCADs, who underwent initial ESD or total proctocolectomy at the Hiroshima University Hospital. The clinicopathological features of the patients and neoplasias and clinical outcomes of ESD were evaluated and compared with those of total proctocolectomy. Results: UCAD in the ESD and total proctocolectomy groups was mostly noted on the left side of the colon, and most lesions were superficial macroscopic lesions. In the ESD group, en bloc resection and histological complete resection rates were 83 and 67%, respectively. One patient died of malignant melanoma; however, none of the patients died of UC-associated carcinoma in both groups. Metachronous neoplasias developed in 5 of the 7 patients in the ESD group. Among the 5 patients with metachronous UCAN, 4 finally underwent total proctocolectomy and 1 underwent additional ESD. Conclusions: ESD for UCAD is a useful method for total excisional biopsy. UC patients with UCAD resected by ESD have a high risk of developing metachronous UCAN during the follow-up period.

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“…The procedures carried out in our center used high‐definition endoscopes (Olympus 260/290 series), without the use of magnifying endoscopy. Magnifying endoscopy is a promising modality in the optical diagnosis of IBD lesions; however, we are unable to comment on the role of this technology in IBD surveillance. However, given that magnifying endoscopy is not in widespread in the West, our results are likely to reflect “real‐life” practice.…”

Section: Discussionmentioning

confidence: 88%

Performance measures in inflammatory bowel disease surveillance colonoscopy: Implementing changes to practice improves performance

Smith

Cannatelli

Bazarova

et al. 2019

Digestive Endoscopy

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Background and Aim: Dye-based chromoendoscopy (DCE) with targeted biopsies is recommended for inflammatory bowel disease (IBD) surveillance. However, DCE has not yet been widely adopted into clinical practice. We evaluated quality indicators in IBD surveillance following introduction of structured changes in service delivery.Methods: In August 2016, we introduced a number of changes to IBD surveillance practice in our endoscopy unit. These included training using interactive videos/images in a structured module, DCE as standard by using a foot-pedal operated pump jet, allocation of 45-minute procedure timeslots, targeted biopsies (except in high-risk patients), scoring of endoscopic disease activity, and lesion detection/morphology characterization. All IBD surveillance colonoscopies were allocated to a small team of four DCE-trained endoscopists. We compared quality measures for surveillance procedures carried out pre-and post-August 2016. The two groups were compared using chi-squared statistics Results: A total of 598 IBD surveillance procedures (277 pre-August 2016 and 321 post-August 2016) were done and included in the study. Use of DCE increased (54.2% vs 76.0% P < 0.0005) whereas random biopsy surveillance decreased (12.3% vs 3.1% P < 0.0005). Use of Paris classification (26.1% vs 57.0% P < 0.0005) and Kudo pit pattern increased (21.7% vs 59.0% P < 0.0005). There was also an increase in lesion detection rate (24.9% vs 33.1% P < 0.05).Conclusions: Implementation of extensive changes in practice of surveillance colonoscopy resulted in significant improvement in quality indicators within a short period of time. Training, education and audit may continue to facilitate the adoption of DCE and further improve quality of performance in IBD surveillance.

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Endoscopic diagnosis and treatment of ulcerative colitis‐associated neoplasia

Cited by 11 publications

References 13 publications

Long-Term Follow-Up of Targeted Biopsy Yield (LOFTY Study) in Ulcerative Colitis Surveillance Colonoscopy

Long-Term Follow-Up of Targeted Biopsy Yield (LOFTY Study) in Ulcerative Colitis Surveillance Colonoscopy

Long-Term Outcomes after Endoscopic Submucosal Dissection for Ulcerative Colitis-Associated Dysplasia

Performance measures in inflammatory bowel disease surveillance colonoscopy: Implementing changes to practice improves performance

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