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Chromoendoscopy effectively detected dysplasia in patients with UC
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Chromoendoscopy with targeted colonic biopsies is more effective than random biopsies in detecting dysplasia in patients with ulcerative colitis, and its accuracy and easy implementation warrant greater adoption into clinical practice, according to recent findings.
In an implementation study, researchers described chromoendoscopy (CE) and supported its benefits in accuracy, reproducibility, and superiority compared with multiple randomly conducted mucosal biopsies in patients with inflammatory bowel disease (IBD).
Perceived obstacles to widespread adoption of CE were cited, including availability, lack of experience by the endoscopist, reliability of image interpretation, costs, and extended procedure time. The researchers wrote that by implementing a standardization of procedure, training, and quality assurance these issues are avoidable.
The researchers studied the adoption of CE at three academic sites for surveillance colonoscopy and selected six gastroenterologists without expertise in IBD to utilize CE. As part of their training, the endoscopists underwent a brief session and reviewed literature, a file of video images and a general tutorial on CE technique and practice protocol.
Two of the endoscopists performed the first procedures to perfect the technique and optimize protocol. The clinicians chose indigo carmine in the flushing pump and also agreed that any large or challenging lesions should be referred to an endoscopic resection expert.
The researchers evaluated withdrawal times from the cecum, as well as accuracy of image interpretation. They cited excellent agreement in image evaluation for white light and CE. Dysplasia detection rates were similar to previously reported data.
A learning curve existed in optimizing procedure time, the researchers said, but withdrawal time decreased with experience. It ranged from 31 minutes for doctors who had performed fewer than five CE procedures to 19 minutes for those who conducted more than 15.
“CE with targeted colonic biopsies identifies dysplasia more readily than random biopsies, and this evidence-based approach should therefore be adopted into group and solo practice,” the researchers wrote. “The technique is easy and requires a low level of equipment. Mechanisms for its implementation include standardization of protocol and training, and ensuring quality metrics.”
Disclosure: The researchers report no relevant financial disclosures.
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