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Chromoendoscopy versus Narrow Band Imaging for Colonic Surveillance in Inflammatory Bowel Disease

Efthymiou, Marios MD, PhD*,†; Allen, Patrick B. MD*; Taylor, Andrew C. F. MD, PhD*; Desmond, Paul V. MD, PhD*; Jayasakera, Chatura MD*,†; De Cruz, Peter MD*,†; Kamm, Michael A. MD, PhD*,†,‡

doi: 10.1097/MIB.0b013e31829637b9
Original Clinical Articles

Background: Mucosal dye spraying (chromoendoscopy [CE]) has been shown in controlled studies to enhance lesion detection in colitis surveillance. Narrow band imaging (NBI) potentially offers a more convenient mode of highlighting mucosal lesions. The primary objectives of this study were to compare CE and NBI in colitis surveillance with respect to lesion detection. A secondary objective was to assess the accuracy of the mucosal pit pattern (Kudo classification) with NBI in predicting mucosal histology.

Methods: Patients with colitis of 8 years or greater disease duration underwent screening colonoscopy with NBI, followed immediately by CE by 2 endoscopists blinded to each other’s results. All lesions were biopsied to confirm histology. Diagnostic yield of each modality for dysplastic lesions. Accuracy of Kudo classification by NBI for neoplasia.

Results: Forty-four participants were enrolled. One hundred forty-four colonic lesions were identified in total. Overall, CE identified more lesions than NBI (131 versus 102, P < 0.001); however, most were nondysplastic. CE detected 23 neoplastic (dysplastic or indefinite for dysplasia) lesions in 11 patients and NBI 20 lesions in 10 patients, P = 0.180. Kudo assessment by NBI had low sensitivity for dysplasia (42%) and modest accuracy (74%) for dysplasia.

Conclusions: NBI detected fewer lesions than CE in chronic colitis; however, most were not dysplastic. There was a nonsignificant trend in favor of CE for detection of dysplasia. At present, NBI cannot be recommended as an alternative to CE for dysplasia surveillance in colitis.

Article first published online 30 July 2013

*Department of Gastroenterology, St Vincent’s Hospital, Melbourne, Australia;

University of Melbourne, Melbourne, Australia; and

Imperial College, London, United Kingdom.

Reprints: Michael A. Kamm, MD, PhD, St Vincent’s Hospital, Victoria Parade, Fitzroy 3065, Melbourne, Australia (e-mail:

The authors have no conflicts of interest to disclose.

Received March 03, 2013

Accepted April 09, 2013

© Crohn's & Colitis Foundation of America, Inc.
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