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)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: September 23, 2015
Accepted:
September 17,
2015
Received:
April 13,
2015
Footnotes
DISCLOSURE: All authors disclosed no financial relationships relevant to this article.
If you would like to chat with an author of this article, you may contact Dr Deepak at [email protected]
See CME section; p. 1023.
Identification
Copyright
© 2015 American Society for Gastrointestinal Endoscopy.
