High-Definition Chromoendoscopy Superior to High-Definition White-Light Endoscopy in Surveillance of Inflammatory Bowel Diseases in a Randomized Trial

Abstract

BACKGROUND & AIMS: There is debate over the optimal method for colonoscopic surveillance of patients with inflammatory bowel diseases. Guidelines recommend chromoendoscopy, but the value of chromoendoscopy in high-definition colonoscopy has not been proven. Furthermore, the value of random biopsies is controversial. METHODS: We performed a prospective study of 305 patients with ulcerative colitis or Crohn's colitis referred for surveillance colonoscopy at a university hospital in Sweden, from March 2011 through April 2016. Patients randomly assigned to a group that received high-definition chromoendoscopy with indigo carmine (HD-CE; n [ 152), collection of 32 random biopsies, and targeted biopsies or polypectomies or to a group that received high-definition white light endoscopy (HD-WLE; n [ 153), collection of 32 random biopsies, and targeted biopsies or polypectomies. The primary endpoint was number of patients with dysplastic lesions. RESULTS: Dysplastic lesions were detected in 17 patients with HD-CE and 7 patients with HD-WLE (P [ .032). Dysplasias in random biopsies (n [ 9760) were detected in 9 patients: 6 (3.9%) in the HD-CE group and 3 (2.0%) in the HD-WLE group (P [ .72). Of the 9 patients with dysplasia, 3 patients (33%) had primary sclerosing cholangitis-only 18% of patients (54/305) included in the study had primary sclerosing cholangitis. The number of dysplastic lesions per 10 min of withdrawal time was 0.066 with HD-CE and 0.027 with HD-WLE (P [ .056). CONCLUSIONS: In a randomized trial, we found HD-CE with collection of random biopsies to be superior to HD-WLE with random biopsies for detection of dysplasia per colonoscopy. These results support the use of chromoendoscopy for surveillance of patients with inflammatory bowel diseases. ClinicalTrials.gov no: NCT01505842.

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

“…Three recent meta‐analyses 9‐11 have shown that chromoendoscopy identified more patients with dysplasia than WLE, but subgroup analyses confirmed this finding only when chromoendoscopy was compared with SDWLE. Two randomized controlled trials (RCTs) have been published attempting to clarify the role of chromoendoscopy in HDWLE 25,26 . In the former study 25 the detection rate of dysplasia using HDWLE with random biopsy (HDWL‐R) was compared with that using high‐definition chromoendoscopy with targeted biopsy (HDCE‐T).…”

“…However, HDCE‐T showed a trend toward improved colorectal neoplasia detection compared with HDWL‐R (20.6% vs 12.0%, P = 0.093). In another study 26 the detection rate of dysplasia in patients with long‐standing colonic IBD using HDCE and random biopsies was compared with that of HDWLE and random biopsies. It was concluded that HDCE was superior to HDWLE in the detection of dysplasia.…”

Rediscovering histology: what is new in endoscopy for inflammatory bowel disease?

“…51 The superiority of DCE over HD-WLE for identifying dysplasia was confirmed by a recent trial that assigned IBD patients randomly to HD-DCE with indigo carmine (n = 152) or HD-WLE (n = 153). 52 Dysplastic lesions were identified in a more significant number of patients with HD-DCE (17 versus 7, respectively; p = 0.032). 52 However, there is contradictory evidence concerning superiority of DCE over HD-WLE (RR = 1.36; 95% CI, 0.84-2.18), and additional studies are needed to support these data.…”

Issue Highlights

“…Similarly, the value of random biopsies is a topic of debate. In a single-center, prospective, randomized trial conducted in Sweden by Alexandersson et al, 10 305 patients with ulcerative colitis or Crohn's colitis underwent surveillance colonoscopy (152 had HD-CE and 153 had HD-WLE) by 25 endoscopists (median of 6 procedures per endoscopist). In both groups, a collection of 32 random biopsies (4 biopsies from 8 colonic segments) and targeted biopsies or polypectomies were performed.…”