Chromoendoscopy effective for surveillance in IBD patients with history of colorectal dysplasia
Performing chromoendoscopy in inflammatory bowel disease patients with a history of colorectal dysplasia identified lesions that were likely missed during initial white light endoscopy, most of which were endoscopically treatable, according to the results of a retrospective cohort study.
“The recent SCENIC guidelines suggested chromoendoscopy rather than white light endoscopy for initial dysplasia surveillance in inflammatory bowel disease patients. However, the yield of chromoendoscopy in patients with a history of dysplasia on white light endoscopy and the impact of chromoendoscopy on management plans for patients with a history of colorectal dysplasia remain unclear,” Parakkal Deepak, MBBS, from the division of gastroenterology and hepatology at the Mayo Clinic in Rochester, Minn., told Healio Gastroenterology. “Our study findings indicate that chromoendoscopy is better than white light endoscopy at detecting flat dysplasia and also less likely to miss dysplasia in inflammatory bowel disease patients. We also showed that most of the visualized dysplastic lesions during chromoendoscopy can be resected at the time of endoscopy.”
Deepak and colleagues identified 95 IBD patients (78 with ulcerative colitis; median IBD duration, 18 years; median age, 58 years; 68.4% men) with colorectal dysplasia identified during an index white light endoscopy, who subsequently underwent chromoendoscopy from January 2006 through August 2013. They compared endoscopic and histologic findings from the index white light endoscopy, first and subsequent chromoendoscopies. Endoscopic lesion removal, surgery, repeat chromoendoscopy and colorectal cancer diagnosis were the outcomes of interest.
Index white light endoscopy with targeted biopsies identified dysplasia in 55 (57.9%) of the patients, representing 72 lesions.
After a median of 6.1 months, the first chromoendoscopy identified dysplasia in 50 (52.6%) of the patients, including 34 new lesions that were not visualized on the index white light endoscopy. Forty-three of these lesions were successfully resected, most of which were located in the cecum/ascending colon and had sessile morphology.
First chromoendoscopy was more likely to detect flat dysplasia compared with white light endoscopy (OR = 19.3; 95% CI, 9.5-39.3) and was 93% less likely to miss dysplasia compared with white light endoscopy (OR = .07; 95% CI, 0.03-0.14).
Fourteen (28%) of the patients underwent surgery after their first chromoendoscopy, which revealed two cases of colorectal cancer and three cases of high-grade dysplasia. Forty-four (66.7%) of the patients underwent subsequent chromoendoscopy, which identified 26 new lesions in 20 patients.
“This study demonstrated that performing [chromoendoscopy] in IBD patients with a history of colorectal dysplasia on [white light endoscopy] identified new lesions likely missed on initial [white light endoscopy] examination, which were often amenable to endoscopic resection,” the researchers concluded. “Furthermore, continued surveillance with [chromoendoscopy] identified additional lesions amenable to endoscopic resection. The miss rate for colorectal dysplasia was lower with [chromoendoscopy] than with [white light endoscopy] in this high-risk population.”
“Interestingly, [this study] is the first to report longitudinal data on the use of an alternative and relatively inexpensive chromoendoscopy agent, .2% FD&C Blue #2 Solution,” Tonya Kaltenbach, MD, from the Veterans Affairs Palo Alto Healthcare System and Stanford University School of Medicine, and colleagues wrote in a related editorial. “Further high-quality studies of alternative chromoendoscopy dyes, such as this food coloring agent, will be important to determine if high-quality examination can be achieved at lower cost.
“Widespread improvement in the endoscopic recognition of dysplastic colorectal lesions could have important implications for the surveillance and management of dysplasia,” they added. “Targeted sampling and resection of visible lesions may allow a shift in practice away from the random biopsy technique, where less than .1% of the colonic mucosal surface area is blindly samples, and away from colectomy for the management of dysplasia.” – by Adam Leitenberger
Disclosure: The researchers report no relevant financial disclosures. Kaltenbach reports she has received nonsalary research support and consults for Olympus. Another editorial author reports he has also received nonsalary research support from Olympus.