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Virtual Chromoendoscopy Could Replace Gold Standard for UC Surveillance
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Virtual chromoendoscopy with narrow band imaging was comparable to the gold standard classical chromoendoscopy for detecting neoplasia in patients with long-standing ulcerative colitis in a randomized controlled trial.
These findings suggest that narrow band imaging (NBI) could replace chromoendoscopy (CE) for surveillance of colitis-associated neoplasia in the future, given its “shorter procedural time and easier applicability,” researchers concluded.
To compare the performance of these two modalities, Paul Rutgeerts, MD, and colleagues from the department of gastroenterology at University Hospital Gasthuisberg in Belgium, prospectively evaluated 131 patients with long-standing UC (56% men) from two centers in Belgium and one in Canada between 2008 and 2013. They randomly assigned patients to undergo methylene blue chromoendoscopy or virtual chromoendoscopy with NBI, taking biopsies from suspicious areas but no random biopsies.
They found no significant differences between NBI and conventional chromoendoscopy regarding neoplasia detection rate, per lesion neoplasia detection rate or median number of lesions per colonoscopy.
The average number of lesions detected per colonoscopy was 0.32 for NBI vs. 0.47 for CE, neoplasia detection rates were 21.5% vs. 21.2% (OR = 1.02; 95% CI, 0.44-2.35), and per lesion neoplasia detection rates were 16.3% vs. 17.4% (OR = 1.09; 95% CI, 0.59-1.99).
Researchers did not detect dysplasia in any of the biopsies collected from around visible lesions, and there were no neoplastic changes in over 80% of the targeted lesions.
Finally, NBI procedures were significantly shorter, taking an average of 7 minutes less than conventional chromoendoscopy.
“Although our study was not designed as a non-inferiority trial, the similar rates of dysplasia detection achieved by NBI in a large number of patients suggests that NBI may replace classical CE in the future. In particular, its ease of use and shorter procedure time are advantages and may facilitate a more widespread use,” Rutgeerts and colleagues wrote.
“NBI has several clinical advantages compared with CE,” they continued. “First, it is easier and less messy to apply. The potential — although clinically not proven relevant — effect of DNA damage by methylene blue does not apply to NBI. It decreases the time of the procedure significantly. Finally, even in case of a suboptimally prepared colon, NBI is easier to apply than CE.” – by Adam Leitenberger
Disclosures: One of the researchers reports receiving speaking fees and research support from Olympus not related to this trial.
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