Chromoendoscopy can improve dysplasia detection in IBD

Francis A. Farraye

BOSTON – Chromoendoscopy used in conjunction with targeted biopsies helps maximize detection of dysplasia in patients with inflammatory bowel disease, according to a presentation given at the Interdisciplinary Autoimmune Summit.

The presenter, Francis A. Farraye, MD, MSc, clinical director in the section of gastroenterology at Boston Medical Center, said chromoendoscopy is an advance that can increase the endoscopic detection of dysplasia while decreasing the need for random colonic biopsies. However, it has led to some variation between guidelines.

“It has generated significant controversy,” Farraye said. “Many gastroenterologists don’t believe that chromoendoscopy is necessary and that it adds a lot of time to the procedure. That’s not true. After learning the technique and abandoning random biopsies, you can perform the procedure in the same amount of time as a colonoscopy with multiple random biopsies.”

While some studies have shown that chromoendoscopy did not increase dysplasia detection compared to high definition white light endoscopy, Farraye said those results are “unfair,” because several of these studies only compared procedures done by expert endoscopists who already had a very high rate of dysplasia detection. Most experts do agree however that high risk patients such as those with colonic scarring, pseudopolyps and a history of previous dysplasia merit a chromoendoscopic exam, he added.

Farraye noted that researchers have argued that lack of experience in chromoendoscopy should not be a limitation for its implementation in real-world practice and that a number of online resources are available to help gastroenterologists learn the technique.

He also gave several recommendations to ensure clinicians take full advantage of chromoendoscopy:

Schedule additional time when learning the technique;

Excellent bowel preparation is necessary removing all residual fluid and bowel contents during insertion of the colonoscope and before spraying the dye;

Perform chromoendoscopy sequentially in each segment of the colon; and

Use gravity to facilitate dye application and avoid pooling.

Despite the apparent success of chromoendoscopy, Farraye said more research is needed to clear up guideline discrepancies, understand if surveillance intervals can be lengthened after a negative chromoendoscopic exam and implement successful teaching strategies.

“I would argue that chromoendoscopy detects more dysplasia than high definition white light endoscopy,” he said. “We need additional prospective data that chromoendoscopy decreases the incidence of colorectal cancer in IBD patients.” – by Alex Young

Disclosures: Farraye reports no relevant financial disclosures.