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

Abstract

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.

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

“…Subsequent studies confirmed the low yield of random biopsies [51,[56][57][58]. Interestingly, these findings were corroborated by the retrospective study of Hata et al, where HD-WLE with only targeted biopsies have proven to be as effective over the long-term as targeted plus random biopsies with no death from CRC in both groups with median 8.8-year follow-up [59]. In addition, a cost-effectiveness analysis by Konijeti et al found that DCE with targeted biopsies was more effective and less costly than WLE with random biopsies.…”

“…Thus, the authors concluded that surveillance with only targeted biopsies could emerge as a more cost-effective strategy [58]. These results were consolidated by a subsequent retrospective cohort study based on the follow-up data of this RCT demonstrating the long-term effectiveness of targeted biopsies [59]. Indeed, no death by CRC was observed in both arms with a median 8.8-year follow-up.…”

“…In addition, the incidence of advanced neoplasia was similar in each group, and the likelihood of developing high grade dysplasia/CRC in subjects characterized by a negative colonoscopy was low. Once more, the authors suggested targeted biopsy over random biopsies in reallife settings [59]. However, Moussata et al demonstrated that random biopsies, despite their low yield, may still be useful when associated with DCE [60].…”

Practice pattern variability among gastroenterologists in colorectal cancer surveillance and management of colorectal dysplasia in inflammatory bowel disease

“…Prior studies have shown that dysplasia detection from targeted biopsies are similar to and preferred over random biopsies 13‐15 . Importantly, in a follow‐up study 29 that used data from patients with UC for ≥8 years who had enrolled in the initial RCT, 14 no patient died of CRC in either the targeted or the random biopsy group within a median follow‐up of 8.8 years, demonstrating a robustness for targeted biopsy in terms of preventing CRC‐related mortality. On the other hand, there are also emerging data that random biopsies during surveillance chromoendoscopy may be warranted in patients with a personal history of neoplasia, 30 a tubular appearing colon, 30 concomitant primary sclerosing cholangitis, 30,31 long disease duration 31 and those with active inflammation 31 .…”

Efficacy and safety evaluation of hyperbaric oxygen therapy for patients with ulcerative colitis

“…[ 2 ] In addition, diagnosis of UC mainly relies on endoscopy and clinical symptoms. [ 3 ] It has been reported that the occurrence rate of UC is increasing globally. [ 4 ] Furthermore, the incidence of UC is increasing worldwide over the past few years, affecting mostly young individuals.…”