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A Randomized Trial Comparing High Definition Colonoscopy Alone With High Definition Dye Spraying and Electronic Virtual Chromoendoscopy for Detection of Colonic Neoplastic Lesions During IBD Surveillance Colonoscopy

Iacucci, Marietta MD, PhD1,2; Kaplan, Gilaad G MD1; Panaccione, Remo MD1; Akinola, Oluseyi MD1; Lethebe, Brendan Cord3; Lowerison, Mark3; Leung, Yvette MD1; Novak, Kerri L MD1; Seow, Cynthia H MD1,3; Urbanski, Stefan MD4; Minoo, Parham MD4; Gui, Xianyong MD4; Ghosh, Subrata MD, PhD1,2

American Journal of Gastroenterology: February 2018 - Volume 113 - Issue 2 - p 225–234
doi: 10.1038/ajg.2017.417
ORIGINAL CONTRIBUTIONS: ENDOSCOPY
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OBJECTIVES: Dye spraying chromoendoscopy (DCE) is recommended for the detection of colonic neoplastic lesions in inflammatory bowel disease (IBD). The majority of neoplastic lesions are visible endoscopically and therefore targeted biopsies are appropriate for surveillance colonoscopy. To compare three different techniques for surveillance colonoscopy to detect colonic neoplastic lesions in IBD patients: high definition (HD), (DCE), or virtual chromoendoscopy (VCE) using iSCAN image enhanced colonoscopy.

METHODS: A randomized non-inferiority trial was conducted to determine the detection rates of neoplastic lesions in IBD patients with longstanding colitis. Patients with inactive disease were enrolled into three arms of the study. Endoscopic neoplastic lesions were classified by the Paris classification and Kudo pit pattern, then histologically classified by the Vienna classification.

RESULTS: A total of 270 patients (55% men; age range 20–77 years, median age 49 years) were assessed by HD (n=90), VCE (n=90), or DCE (n=90). Neoplastic lesion detection rates in the VCE arm was non-inferior to the DCE arm. HD was non-inferior to either DCE or VCE for detection of all neoplastic lesions. In the lesions detected, location at right colon and the Kudo pit pattern were predictive of neoplastic lesions (OR 6.52 (1.98–22.5 and OR 21.50 (8.65–60.10), respectively).

CONCLUSIONS: In this randomized trial, VCE or HD-WLE is not inferior to dye spraying colonoscopy for detection of colonic neoplastic lesions during surveillance colonoscopy. In fact, in this study HD-WLE alone was sufficient for detection of dysplasia, adenocarcinoma or all neoplastic lesions.

1Inflammatory Bowel Disease Clinic Division of Gastroenterology & Hepatology, Department of Medicine, University of Calgary, Cumming School of Medicine, Calgary, Canada

2Division of Gastroenterology & Institute of Translational Medicine, NIHR Biomedical Research Center, Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK

3Department of Community Health Sciences, Clinical Research Unit, Cumming School of Medicine, University of Calgary, Calgary, Canada

4Department of Pathology, University of Calgary, Cumming School of Medicine, Calgary, Canada

Correspondence: Marietta Iacucci, MD, PhD, Reader/Senior Associate Professor of Gastroenterology, Institute of Translational Medicine, Heritage Building Research & Development, University of Birmingham, University Hospital Birmingham NHS Foundation Trust, Edgbaston, Birmingham B15 2TT, UK. E-mail: m.iacucci@bham.ac.uk

published online 14 November 2017

Received 24 May 2017; accepted 12 September 2017

© The American College of Gastroenterology 2018. All Rights Reserved.
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