High-definition chromoendoscopy improves detection of dysplasia in UC patients
WASHINGTON — Compared with high-definition white light endoscopy, high-definition chromoendoscopy was associated with significantly improved detection of dysplastic lesions in patients with long standing ulcerative colitis, according to data presented at Digestive Disease Week.
“The question we asked ourselves was, ‘Is there a role for chromoendoscopy when we use high definition equipment?’” Venkat Subramanian, MD, from St. James University Hospital and University of Leeds in the United Kingdom, said in his presentation. “We did a randomized trial that compared the detection of dysplasia in patients with long standing ulcerative colitis when we used high-definition white light alone compared to high definition with chromoendoscopy.”
Subramanian and colleagues used high-definition endoscopes (Olympus CF260L or 290L), processors (Olympus Spectrum CV260 or Elite CV290) and monitors for all procedures for this parallel group trial. Overall, 53 patients were randomly assigned to high-definition white light endoscopy and 50 to high-definition chromoendoscopy; all patients had longstanding (more than 10 years) extensive ulcerative colitis that required surveillance colonoscopy.
A total of 14 dysplastic lesions (one high grade, 13 low grade) were detected in 22% of the high-definition chromoendoscopy group compared with six lesions (all low grade) detected in 9.4% of the high-definition white light endoscopy group. Per-patient analysis demonstrated that high-definition chromoendoscopy was superior for detection of endoscopically visible dysplastic lesions (P = .04), detecting 0.26 ± 0.6 lesions per patient compared with 0.12 ± 0.4 per patient with high definition white light endoscopy. Withdrawal time was also higher with high-definition chromoendoscopy (21.2 ± 5.8 min) compared with high-definition white light endoscopy (13.6 ± 3.3 min; P < 0.001).
“High-definition chromoendoscopy significantly improves the detection of dysplastic lesions in patients with ulcerative colitis undergoing surveillance colonoscopy and should be the procedure of choice in these patients,” Subramanian concluded. “On average, it increases procedure time by about 8 minutes, but abandoning random biopsies could make up for some of this extra time.
“A UK-wide study of about 1,600 participants [is] now currently being initiated to look at this question in detail in various practice settings,” he added. – by Adam Leitenberger
For more information:
Mohammed N, et al. Abstract 446. Presented at: Digestive Disease Week, May 16-19, 2015; Washington, D.C.
Disclosure: Subramanian reports he was involved in formulating the SCENIC guidelines for detection and management of dysplastic lesions in IBD, but has no relevant financial disclosures. Please see the DDW faculty disclosure index for all other researchers’ relevant financial disclosures.