White-Light or Narrow-Band Imaging Colonoscopy in Surveillance of Ulcerative Colitis: A Prospective Multicenter Study

Abstract

BACKGROUND & AIMS:Early detection of neoplastic lesions is essential in patients with long-standing ulcerative colitis but the best technique of colonoscopy still is controversial. METHODS:We performed a prospective multicenter study in patients with long-standing ulcerative colitis. Two colonoscopies were performed in each patient within 3 weeks to 3 months. In white-light (WL) colonoscopy, stepwise random biopsy specimens (4 biopsy specimens every 10 cm), segmental random biopsies (2 biopsy specimens in 5 segments), and targeted biopsy specimens were taken. In NBI colonoscopy, segmental and targeted biopsy specimens were taken. The sequence of WL and NBI colonoscopy was randomized. RESULTS:In 36 of 159 patients enrolled (22.6%), 54 lesions with intraepithelial neoplasia (IN) were found (51 low-grade, 3 high-grade). In WL colonoscopy we found 11 IN in stepwise biopsy specimens, 4 in segmental biopsy specimens, and 15 in targeted biopsy specimens. In NBI colonoscopy 7 IN were detected in segmental biopsy specimens and 24 IN were detected in targeted biopsy specimens. Almost all IN were found with one technique alone (k value of WL vs NBI, -0.86; P < .001). Statistically equivalent numbers of IN were found in NBI colonoscopywith targeted and segmental biopsy specimens as in WL colonoscopy with targeted and stepwise biopsy specimens, but with fewer biopsy specimens (11.9 vs 38.6 biopsy specimens, respectively; P < .001), and less withdrawal time was necessary (23 vs 13 min, respectively; P < .001). CONCLUSIONS:Stepwise biopsy specimens are indispensable in WL colonoscopy. The combination of targeted and segmental biopsy specimens in the NBI technique is as sensitive as targeted together with stepwise biopsy specimens in WL colonoscopy, but requires fewer biopsy specimens and less time. The highest sensitivity should be reached by combining the WL and NBI techniques by switching between the modes.

Systematic review with network meta‐analysis: endoscopic techniques for dysplasia surveillance in inflammatory bowel disease

“…The search retrieved 565 citations (Figure ). Twenty‐one trials involving 2889 participants with IBD were eligible for inclusion in the review . We could not extract data from three crossover trials because results at the end of the first phase of the study were not reported.…”

Endoscopic evaluation in diagnosis and management of inflammatory bowel disease

“…These findings contrast with a large retrospective study, which found no difference between CE and WLE with random and targeted biopsies, in detection rates for dysplasia[62]. Narrow band imaging has not been shown to be superior to white light endoscopy for detecting dysplasia in patients with IBD[63,64]. CE with targeted biopsies are more cost effective than traditional WLE endoscopy with random biopsies[65], and are recommended as preferred method of surveillance in recent guidelines[2,4,48].…”

Advanced imaging in colonoscopy: contemporary approach to dysplasia surveillance in inflammatory bowel disease

“…In addition, the random biopsy strategy has been criticised due to implications involving cost, clinician adherence, low dysplasia yield and minimal clinical impact 9 12 36. On the other hand, a large retrospective real-life cohort study from the Netherlands has recently questioned the superiority of CE over WLE with targeted and random biopsies in terms of dysplasia yield,37 and authors of a randomised study from Germany found a significant yield of dysplasia in random biopsies during WLE surveillance concluding that random sampling is indispensable when CE is not performed 38 Table 4. summarises data on dysplasia yield with random versus targeted biopsies in SD and HD colonoscopy compared with CE.…”