Chromoendoscopy superior for detection of dysplasia in patients with IBD
Chromoendoscopy was found to be more effective than random biopsy or white-light colonoscopy for detecting dysplasia in patients with inflammatory bowel disease in a long-term surveillance study.
“While there has been a growing consensus on the superiority of chromoendoscopy compared to other dysplasia surveillance methods over the last decade, these results are the first to demonstrate this superiority through long-term surveillance,” James F. Marion, MD, professor of medicine at Icahn School of Medicine at Mount Sinai, and director of education and outreach at The Susan and Leonard Feinstein IBD Center at The Mount Sinai Hospital, said in a press release. “Since patients with IBD are at an estimated five to ten times greater risk of developing colorectal cancer, it is important to be able to accurately detect dysplasia, so we can prevent cancer morbidity and mortality, while also reducing unnecessary surgeries to remove the colon.”
James F. Marion
Marion and colleagues prospectively studied 44 men and 24 women who were diagnosed with ulcerative colitis (n = 55) or Crohn’s disease (n = 13) at Mount Sinai Medical Center from September 2005 through October 2011. All patients were followed for a median of 27.8 months (IQR = 15.3-45.2) from June 2006 through October 2011, and were each evaluated by random biopsy, targeted white-light examination and methylene blue chromoendoscopy. Detection of dysplasia for each method served as the primary outcome.
Overall, 208 examinations were performed (mean, 3.15 [1-5] endoscopies per patient) and 44 dysplastic lesions were detected in 24 patients; six by random biopsy, 11 by white-light examination and 27 by chromoendoscopy. A total of ten patients were referred for colectomy and no carcinomas were found.
Throughout the study period, dysplasia was more likely to be detected using chromoendoscopy (OR = 5.4; 95% CI, 2.9-9.9) or targeted white-light examination (OR = 2.3; 95% CI, 1-5.3) compared with random biopsy, and chromoendoscopy was more effective than white-light examination (OR = 2.4; 95% CI, 1.4-4).
No adverse events occurred, and patients who were positive for dysplasia were more likely to have colectomy sooner (HR = 12.1; 95% CI, 3.2-46.2).
“Despite the abundant evidence supporting improved dysplasia detection in patients with IBD through chromoendoscopy screening and its incorporation into our guidelines, many gastroenterologists continue to rely on expensive random biopsies for detection of dysplasia and colorectal cancer,” Marion said in the press release. “We hope these long-term findings resonate throughout the GI community and prompt screening changes, thus improving patient outcomes. Chromoendoscopy is an inexpensive, easy-to-learn technique that allows us to manage our patients without surgery. Our current guidelines will need to be revisited.” – by Adam Leitenberger
Disclosures: The researchers report no relevant financial disclosures.