Use and barriers to chromoendoscopy for dysplasia surveillance in inflammatory bowel disease

Abstract

Traditionally, patients with inflammatory bowel disease (IBD) have been thought to be at increased risk of developing colitis-associated colorectal cancer. Although there are recent data suggesting that rates of colitis-associated cancer in IBD patients is declining, current guidelines still recommend regular dysplasia surveillance for early detection and prevention of neoplasia in patients with IBD. White-light endoscopy with random biopsies has been the traditional approach for dysplasia detection; however, newer technologies and approaches have emerged. One method, dye-based chromoendoscopy, has the potential to detect more dysplasia. However, longitudinal data to showing a benefit in morbidity or mortality from the use of chromoendoscopy are still lacking. Many societies have included recommendation on the use of chromoendoscopy with targeted biopsies as a method of surveillance for colitis - associated colorectal cancer. This narrative review seeks to outline data on dysplasia detection as well as barriers to the implementation of dye-based chromoendoscopy for the prevention and early detection of colitis-associated colorectal cancer.

Screening for colorectal cancer in patients with inflammatory bowel disease. Should we already perform chromoendoscopy in all our patients?

“…We concur with Shukla et al[ 10 ] on the need for more studies, particularly longitudinal studies to clarify the role of chromoendoscopy in achieving the objective of reducing morbidity and mortality among patients with colitis-associated CRC, while reducing the number of unnecessary colectomies in patients with clinically insignificant lesions. Similarly, we should stress the need for studies comparing chromoendoscopy and NBI.…”

“…No differences in diagnostic yield were demonstrated for NBI in comparison with other modalities[ 9 ]. Therefore, we have sufficient evidence to recommend implementation of this technique in digestive endoscopy units, as recently shown by Shukla et al[ 10 ].…”

Meta-analysis of dye-based chromoendoscopy compared with standard- and high-definition white-light endoscopy in patients with inflammatory bowel disease at increased risk of colon cancer

“…38 Overall, chromoendoscopy is safe, but it does increase procedural time. 39 The additional procedural time likely results in increased sedation time, which may increase the risk of adverse events from prolonged sedation. If HDWLE is equal to chromoendoscopy, it is unclear if this additional sedation time is worthwhile if the technique is not providing a clear additive benefit in the overall ability to detect dysplasia.…”

Fluorescence tumor imaging by i.v. administered indocyanine green in a mouse model of colitis‐associated colon cancer

“…Inflammatory bowel disease, such as Crohn's disease or ulcerative colitis, is a risk factor for the development of colitis-associated colorectal cancer. [1][2][3] It is difficult to detect colitis-associated colorectal cancer using white-light colonoscopy because of the background mucosal changes associated with long-term colitis and morphological diversity of the cancer. 4 Therefore, for screening colonoscopy to detect dysplasia or early stage cancer, four random biopsies every 10 cm of the whole colorectal tissue using white-light endoscopy has traditionally been recommended.…”

“…Inflammatory bowel disease, such as Crohn's disease or ulcerative colitis, is a risk factor for the development of colitis‐associated colorectal cancer . It is difficult to detect colitis‐associated colorectal cancer using white‐light colonoscopy because of the background mucosal changes associated with long‐term colitis and morphological diversity of the cancer .…”