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Is It Possible to Discriminate Between Neoplastic and Nonneoplastic Lesions in Ulcerative Colitis by Magnifying Colonoscopy?

Nishiyama, Soki MD*; Oka, Shiro MD; Tanaka, Shinji MD; Hayashi, Nana MD*; Hayashi, Ryohei MD*; Nagai, Kenta MD*; Ueno, Yoshitaka MD; Shimamoto, Fumio MD; Arihiro, Koji MD§; Chayama, Kazuaki MD*

doi: 10.1097/01.MIB.0000441199.33325.75
Original Clinical Articles

Background: Colitis-associated cancer/dysplasia is an intestinal tract condition that can affect the life expectancy of patients with ulcerative colitis. It is often difficult to detect neoplastic lesions. This study evaluated whether any endoscopic features are effective for distinguishing colitis-associated cancer/dysplasia from nonneoplastic lesions in patients with ulcerative colitis.

Methods: The study involved 52 patients with 61 lesions treated at Hiroshima University Hospital between September 1999 and May 2012: 10 patients with 11 dysplastic lesions, 5 patients with 5 intramucosal carcinomas, 3 patients with 3 submucosal carcinomas, and 34 patients with 42 nonneoplastic lesions. All patients had undergone targeted biopsy. Endoscopic findings were compared between patients with biopsy-determined neoplasia and those with biopsy-determined nonneoplasia. Multivariate regression analysis was performed to identify magnifying chromocolonoscopy features predictive of neoplasia.

Results: No significant difference was found in conventional endoscopy features between the neoplastic and nonneoplastic lesions. Under magnifying chromocolonoscopy, the pit density of the neoplastic lesions was found to be significantly greater than that of the nonneoplastic lesions (89% [17/19] versus 60% [25/42], respectively). Pit margins were more frequently irregular in the neoplastic lesions than in the nonneoplastic lesions (63% [12/19] versus 33% [14/42], respectively).

Conclusions: In differentiating between colitis-associated neoplastic and nonneoplastic lesions, focus should be on the high residual density of pits and irregular pit margins observed under magnifying chromocolonoscopy.

Article first published online 9 January 2014

*Department of Gastroenterology and Metabolism, Graduate School of Biomedical Sciences, Hiroshima University, Hiroshima, Japan;

Department of Endoscopy, Hiroshima University Hospital, Hiroshima, Japan;

Faculty of Human Culture and Science, Prefectural University of Hiroshima, Hiroshima, Japan; and

§Department of Pathology, Hiroshima University Hospital, Hiroshima, Japan.

Reprints: Shiro Oka, MD, Department of Endoscopy, Hiroshima University Hospital, 1-2-3 Kasumi, Minami-ku, 734-0037, Hiroshima, Japan (e-mail:

The authors have no conflicts of interest to disclose.

Received November 23, 2013

Accepted December 4, 2013

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