NEW YORK (Reuters Health)By Will Boggs MD - Chromoendoscopy may improve the detection of neoplasia in patients with long-standing inflammatory bowel disease (IBD) in a non-trial clinical setting, researchers from Spain report.
The "dysplasia-detection rate was superior with chromoendoscopy (CE) than with white light even when using high-definition scopes," Dr. María Pellisé from Universitat de Barcelona told Reuters Health by email. "Even non-CE expert endoscopists were able to rule out dysplasia with high accuracy."
Several randomized, controlled trials have demonstrated the benefits of CE over white-light endoscopy in identifying IBD-associated dysplasia, but there is little evidence on its effectiveness in clinical settings outside of clinical trials.
Dr. Pellisé and colleagues from EndoCAR group of the Spanish Gastroenterological Association and Spanish Digestive Endoscopy Society evaluated the effectiveness and learning curve of CE plus targeted biopsies for detection and characterization of IBD-associated dysplasia in 350 patients at 15 clinical centers.
In 61% of patients, at least one lesion was biopsied or removed, the team reports in Gut, online September 9.
Among a total of 597 lesions included in the analysis, 94 harbored dysplasia, for a dysplasia-detection yield of 15.7%. Low-grade dysplasia was present in 88, high-grade dysplasia was present in five, and one was an invasive colorectal carcinoma (CRC).
During two to four years' follow-up, none of the patients with dysplastic lesions or colorectal carcinoma required surgery related to those lesions.
CE identified 409 lesions in addition to the 188 detected with white light, for an incremental detection yield for CE of 68.5%. This included 54 new dysplastic lesions.
The incremental detection yield of CE was comparable between standard-definition and high-definition procedures and for CE-expert and CE-non-expert endoscopists.
The overall accuracy for optical diagnosis of dysplasia was 87.4% (70% sensitivity, 90% specificity, 58% positive predictive value, and 94% negative predictive value).
Endoscopic features associated with dysplasia included location in the proximal colon, protruding morphology, loss of innominate lines, and neoplastic pit pattern. The global accuracy of this combination of findings was 85%, although it lacked sensitivity (10%).
"We consider that CE-targeted biopsies should be the standard of care for IBD surveillance," Dr. Pellisé said.
"We need more multicenter studies evaluating the impact of this surveillance strategy in terms of CRC incidence, interval CRC, and CRC mortality," she added. "We also need to better establish the surveillance intervals and the groups of risk."
Dr. Vineet Ahuja and Dr. Sawan Bopanna from All India Institute of Medical Sciences, New Delhi, India, who recently reported on dysplasia surveillance in ulcerative colitis, told Reuters Health in a joint email, "Chromoendoscopy should replace classical random biopsy protocol as the standard of care for screening and surveillance of IBD patients for colorectal cancer and dysplasia."
"Every patient with pancolitis or left colitis who has ten years of disease duration should undergo a screening chromoendoscopy," they said.
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