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Chromoendoscopy for IBD Surveillance Fails to Increase Dysplasia Detection
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Chromoendoscopy for surveillance in patients with inflammatory bowel disease does not increase detection of dysplasia compared with conventional white light endoscopy with random biopsy sampling, according to recent study data.
In order to compare neoplasia detection rates between colonoscopies performed with chromoendoscopy vs. white light endoscopy, Bas Oldenburg, MD, PhD, from University Medical Center Utrecht in the Netherlands, and colleagues performed a large retrospective study of 937 patients with IBD (35% Crohn’s disease; 65% ulcerative colitis or unclassified IBD) who underwent colonoscopic surveillance between January 2000 and November 2013 at three referral centers. White light endoscopy with targeted and random biopsies was the preferred surveillance method at all three centers at the beginning of the study period and was performed in 772 patients (1,802 procedures). Chromoendoscopy was adopted as the preferred surveillance method in recent years at all three centers and was performed in 401 patients (440 procedures).
Bas Oldenburg
Risk factors for IBD-related colorectal cancer were comparable between chromoendoscopy and white light endoscopy groups except for a greater number of patients with CD with extensive colitis (66% vs. 51%; P < .01) and a greater number of patients with a first-degree relative diagnosed with colorectal cancer (16% vs. 4%; P < .01) in the chromoendoscopy group.
Neoplasia was detected in 11% (95% CI, 8-14) of chromoendoscopies compared with 10% (95% CI, 9-12) of white light endoscopies. Targeted biopsies identified neoplasia in 11% of chromoendoscopies compared with 9% of white light endoscopies, with 59 (0.13 ± 0.47) vs. 211 (0.12 ± 0.44) lesions with neoplasia detected, respectively.
“In conclusion, we did not find an increase in neoplasia detection after the implementation of chromoendoscopy as compared with the conventional [white light endoscopy] plus random biopsies protocol,” the investigators wrote. “Although more studies are needed to confirm this and our results could be biased because of the retrospective nature of our study, these results cast doubt on the standard use of chromoendoscopy as the preferred surveillance tool in IBD.” – by Adam Leitenberger
Disclosure: The researchers report no relevant financial disclosures.
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