Incremental diagnostic yield of chromoendoscopy and outcomes in inflammatory bowel disease patients with a history of colorectal dysplasia on white-light endoscopy

Published:September 23, 2015DOI:https://doi.org/10.1016/j.gie.2015.09.021

      Background and Aims

      Chromoendoscopy (CE) identifies dysplastic lesions with a higher sensitivity than white-light endoscopy (WLE). The role of CE in the management of dysplasia on surveillance WLE in inflammatory bowel disease (IBD) remains unclear.

      Methods

      A retrospective cohort of IBD patients with colorectal dysplasia on WLE who subsequently underwent CE between January 1, 2006 and August 31, 2013 was identified. Endoscopic and histologic findings were compared among the index WLE, first CE, and subsequent CE. Outcomes assessed included endoscopic lesion removal, surgery or repeat CE, and diagnosis of colorectal cancer.

      Results

      Ninety-five index cases were identified. The median duration of IBD was 18 years (interquartile range 9.3-29.8); 78 patients had ulcerative colitis. Dysplasia was identified in 55 patients during the index WLE with targeted biopsies of 72 lesions. The first CE visualized dysplastic lesions in 50 patients, including 34 new lesions (not visualized on the index examination). Endoscopic resection was performed successfully of 43 lesions, most in the cecum/ascending colon (n = 20) with sessile morphology (n = 33). After the first CE, 14 patients underwent surgery that revealed 2 cases of colorectal cancer and 3 cases of high-grade dysplasia. Multiple CEs were performed in 44 patients. Of these, 20 patients had 34 visualized lesions, 26 of which were new findings.

      Conclusion

      Initial and subsequent CE performed in IBD patients with a history of colorectal dysplasia on WLE frequently identified new lesions, most of which were amenable to endoscopic treatment. These data support the use of serial CEs in this high-risk population.

      Abbreviations:

      CE (chromoendoscopy), CI (confidence interval), CRC (colorectal cancer), HD (high-definition), HGD (high-grade dysplasia), IBD (inflammatory bowel disease), LGD (low-grade dysplasia), PSC (primary sclerosing cholangitis), UC (ulcerative colitis), WLE (white-light endoscopy)
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      References

        • Eaden J.A.
        • Abrams K.R.
        • Mayberry J.F.
        The risk of colorectal cancer in ulcerative colitis: a meta-analysis.
        Gut. 2001; 48: 526-535
        • Jess T.
        • Gamborg M.
        • Matzen P.
        • et al.
        Increased risk of intestinal cancer in Crohn's disease: a meta-analysis of population-based cohort studies.
        Am J Gastroenterol. 2005; 100: 2724-2729
        • Gupta R.B.
        • Harpaz N.
        • Itzkowitz S.
        • et al.
        Histologic inflammation is a risk factor for progression to colorectal neoplasia in ulcerative colitis: a cohort study.
        Gastroenterology. 2007; 133 (quiz 1340-1): 1099-1105
        • Kornbluth A.
        • Sachar D.B.
        Ulcerative colitis practice guidelines in adults: American College Of Gastroenterology, Practice Parameters Committee.
        Am J Gastroenterol. 2010; 105 (quiz 524): 501-523
        • Farraye F.A.
        • Odze R.D.
        • Eaden J.
        • et al.
        AGA technical review on the diagnosis and management of colorectal neoplasia in inflammatory bowel disease.
        Gastroenterology. 2010; 138 (774.e1-4; quiz e12-3): 746-774
        • Leighton J.A.
        • Shen B.
        • Baron T.H.
        • et al.
        ASGE guideline: endoscopy in the diagnosis and treatment of inflammatory bowel disease.
        Gastrointest Endosc. 2006; 63: 558-565
        • Rubin C.E.
        • Haggitt R.C.
        • Burmer G.C.
        • et al.
        DNA aneuploidy in colonic biopsies predicts future development of dysplasia in ulcerative colitis.
        Gastroenterology. 1992; 103: 1611-1620
        • Eaden J.A.
        • Ward B.A.
        • Mayberry J.F.
        How gastroenterologists screen for colonic cancer in ulcerative colitis: an analysis of performance.
        Gastrointest Endosc. 2000; 51: 123-128
        • van den Broek F.J.
        • Stokkers P.C.
        • Reitsma J.B.
        • et al.
        Random biopsies taken during colonoscopic surveillance of patients with longstanding ulcerative colitis: low yield and absence of clinical consequences.
        Am J Gastroenterol. 2014; 109: 715-722
        • Itzkowitz S.H.
        • Harpaz N.
        Diagnosis and management of dysplasia in patients with inflammatory bowel diseases.
        Gastroenterology. 2004; 126: 1634-1648
        • Kiesslich R.
        • Fritsch J.
        • Holtmann M.
        • et al.
        Methylene blue-aided chromoendoscopy for the detection of intraepithelial neoplasia and colon cancer in ulcerative colitis.
        Gastroenterology. 2003; 124: 880-888
        • Subramanian V.
        • Mannath J.
        • Ragunath K.
        • et al.
        Meta-analysis: the diagnostic yield of chromoendoscopy for detecting dysplasia in patients with colonic inflammatory bowel disease.
        Aliment Pharmacol Ther. 2011; 33: 304-312
        • Laine L.
        • Kaltenbach T.
        • Barkun A.
        • et al.
        • ASGE Technology Committee
        SCENIC international consensus statement on surveillance and management of dysplasia in inflammatory bowel disease.
        Gastrointest Endosc. 2015; 81: 489-501
        • Askling J.
        • Dickman P.W.
        • Ekbom A.
        • et al.
        Family history as a risk factor for colorectal cancer in inflammatory bowel disease.
        Gastroenterology. 2001; 120: 1356-1362
        • Inoue H.
        • Kashida H.
        • Kudo S.
        • et al.
        The Paris endoscopic classification of superficial neoplastic lesions: esophagus, stomach, and colon: November 30 to December 1, 2002.
        Gastrointest Endosc. 2003; 58: S3-43
        • Riddell R.H.
        • Goldman H.
        • Ransohoff D.F.
        • et al.
        Dysplasia in inflammatory bowel disease: standardized classification with provisional clinical applications.
        Hum Pathol. 1983; 14: 931-968
        • Soetikno R.
        • Subramanian V.
        • Kaltenbach T.
        • et al.
        The detection of nonpolypoid (flat and depressed) colorectal neoplasms in patients with inflammatory bowel disease.
        Gastroenterology. 2013; 144 (1352.e1-6): 1349-1352
        • Günther U.
        • Kusch D.
        • Heller F.
        • et al.
        Surveillance colonoscopy in patients with inflammatory bowel disease: comparison of random biopsy vs. targeted biopsy protocols.
        Int J Colorectal Dis. 2011; 26: 667-672
        • Kiesslich R.
        • Goetz M.
        • Lammersdorf K.
        • et al.
        Chromoscopy-guided endomicroscopy increases the diagnostic yield of intraepithelial neoplasia in ulcerative colitis.
        Gastroenterology. 2007; 132: 874-882
        • Hlavaty T.
        • Huorka M.
        • Koller T.
        • et al.
        Colorectal cancer screening in patients with ulcerative and Crohn's colitis with use of colonoscopy, chromoendoscopy and confocal endomicroscopy.
        Eur J Gastroenterol Hepatol. 2011; 23: 680-689
        • Marion J.F.
        • Waye J.D.
        • Present D.H.
        • et al.
        Chromoendoscopy-targeted biopsies are superior to standard colonoscopic surveillance for detecting dysplasia in inflammatory bowel disease patients: a prospective endoscopic trial.
        Am J Gastroenterol. 2008; 103: 2342-2349
        • Rutter M.
        • Saunders B.
        • Schofield G.
        • et al.
        Pancolonic indigo carmine dye spraying for the detection of dysplasia in ulcerative colitis.
        Gut. 2004; 53: 256-260
        • Rubin P.H.
        • Friedman S.
        • Harpaz N.
        • et al.
        Colonoscopic polypectomy in chronic colitis: conservative management after endoscopic resection of dysplastic polyps.
        Gastroenterology. 1999; 117: 1295-1300
        • Kisiel J.B.
        • Loftus E.V.
        • Harmsen W.S.
        • et al.
        Outcome of sporadic adenomas and adenoma-like dysplasia in patients with ulcerative colitis undergoing polypectomy.
        Inflamm Bowel Dis. 2012; 18: 226-235
        • Hurlstone D.P.
        • Sanders D.S.
        • Atkinson R.
        • et al.
        Endoscopic mucosal resection for flat neoplasia in chronic ulcerative colitis: can we change the endoscopic management paradigm?.
        Gut. 2007; 56: 838-846
        • Ullman T.A.
        • Loftus E.V.
        • Kakar S.
        • et al.
        The fate of low grade dysplasia in ulcerative colitis.
        Am J Gastroenterol. 2002; 97: 922-927
        • Lim C.
        • Dixon M.
        • Vail A.
        • et al.
        Ten year follow up of ulcerative colitis patients with and without low grade dysplasia.
        Gut. 2003; 52: 1127-1132
        • Konijeti G.G.
        • Shrime M.G.
        • Ananthakrishnan A.N.
        • et al.
        Cost-effectiveness analysis of chromoendoscopy for colorectal cancer surveillance in patients with ulcerative colitis.
        Gastrointest Endosc. 2014; 79: 455-465
        • Picco M.F.
        • Pasha S.
        • Leighton J.A.
        • et al.
        Procedure time and the determination of polypoid abnormalities with experience: implementation of a chromoendoscopy program for surveillance colonoscopy for ulcerative colitis.
        Inflamm Bowel Dis. 2013; 19: 1913-1920
        • Rutter M.D.
        • Saunders B.P.
        • Wilkinson K.H.
        • et al.
        Thirty-year analysis of a colonoscopic surveillance program for neoplasia in ulcerative colitis.
        Gastroenterology. 2006; 130: 1030-1038
        • Johnson D.
        • Khanna S.
        • Smyrk T.
        • et al.
        Detection rate and outcome of colonic serrated epithelial changes in patients with ulcerative colitis or Crohn's colitis.
        Aliment Pharmacol Ther. 2014; 39: 1408-1417
        • Eluri S.
        • Parian A.M.
        • Limketkai B.N.
        • et al.
        Prevalence and characteristics of previously undetected (surprise) colorectal cancer in colectomy specimens among patients with inflammatory bowel disease [abstract].
        Gastroenterology. 2014; 146: S-444
        • Choi C.-H.R.
        • Rutter M.D.
        • Askari A.
        • et al.
        Forty-year analysis of colonoscopic surveillance program for neoplasia in ulcerative colitis: an updated overview.
        Am J Gastroenterol. 2015; 110: 1022-1034
        • Higgins P.D.
        Miles to go on the SCENIC route: Should chromoendoscopy become the standard of care in IBD surveillance?.
        Am J Gastroenterol. 2015; 110: 1035-1037