Journal Article

Real-life chromoendoscopy for neoplasia detection and characterisation in long-standing IBD

Hernández, Luis, Marín-Garbriel, José Carlos, Ricart, Elena, Pellisé, María, Bustamante-Balén, Marco, Vera, María Isabel, Puig, Ignasi, Carballal, Sabela, Peñas, Beatriz, López-Cerón, María, Álvarez, Marco Antonio, De Castro, Luisa, López-Serrano, Antonio, Jimeno, Mireya, Maisterra, Sandra, Díaz-Tasende, José, Gimeno-García, Antonio Z, Cuatrecasas, Miriam, Acevedo, Juan, Márquez, Lucía, Vega, Pablo, Gordillo, Jordi

2018

Overview

ObjectiveOutside clinical trials, the effectiveness of chromoendoscopy (CE) for long-standing IBD surveillance is controversial. We aimed to assess the effectiveness of CE for neoplasia detection and characterisation, in real-life.DesignFrom June 2012 to 2014, patients with IBD were prospectively included in a multicentre cohort study. Each colonic segment was evaluated with white light followed by 0.4% indigo carmine CE. Specific lesions' features were recorded. Optical diagnosis was assessed. Dysplasia detection rate between expert and non-expert endoscopists and learning curve were ascertained.ResultsNinety-four (15.7%) dysplastic (1 cancer, 5 high-grade dysplasia, 88 low-grade dysplasia) and 503 (84.3%) non-dysplastic lesions were detected in 350 patients (47% female; mean disease duration: 17 years). Colonoscopies were performed with standard definition (41.5%) or high definition (58.5%). Dysplasia miss rate with white light was 40/94 (57.4% incremental yield for CE). CE-incremental detection yield for dysplasia was comparable between standard definition and high definition (51.5% vs 52.3%, p=0.30). Dysplasia detection rate was comparable between expert and non-expert (18.5% vs 13.1%, p=0.20). No significant learning curve was observed (8.2% vs 14.2%, p=0.46). Sensitivity, specificity, and positive and negative predictive values for dysplasia optical diagnosis were 70%, 90%, 58% and 94%, respectively. Endoscopic characteristics predictive of dysplasia were: proximal location, loss of innominate lines, polypoid morphology and Kudo pit pattern III–V.ConclusionsCE presents a high diagnostic yield for neoplasia detection, irrespectively of the technology and experience available in any centre. In vivo, CE optical diagnosis is highly accurate for ruling out dysplasia, especially in expert hands. Lesion characteristics can aid the endoscopist for in situ therapeutic decisions.Trial registration numberNCT02543762.

• Publisher: BMJ Publishing Group LTD
• Subject: Adult / Aged / Biopsy / Cancer / Clinical Competence / Clinical medicine / Clinical trials / Colitis, Ulcerative - complications / Colonoscopy / Colonoscopy - education / Colonoscopy - methods / Colonoscopy - standards / Colorectal cancer / Colorectal Neoplasms - diagnosis / Colorectal Neoplasms - etiology / Colorectal Neoplasms - pathology / Coloring Agents / Crohn Disease - complications / Diagnosis / Dysplasia / Early Detection of Cancer - methods / Education, Medical, Continuing / Endoscopy / Female / Humans / Indigo / Indigo Carmine / Inflammatory bowel disease / Inflammatory Bowel Diseases - complications / Learning Curve / Light / Male / Medical screening / Middle Aged / Observational learning / Precancerous Conditions - diagnosis / Precancerous Conditions - etiology / Precancerous Conditions - pathology / Prospective Studies / Surveillance