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

https://doi.org/10.1016/j.gie.2015.09.021Get rights and content

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.

Section snippets

Methods

The study was approved by the Mayo Clinic Institutional Review Board (PR13-005765-01), and only the medical records of patients who authorized retrospective review of their medical records for research purposes were included in the study. Medical records were abstracted from consecutive IBD patients with colorectal dysplasia detected with WLE (index) colonoscopy who underwent CE at our institution between January 1, 2006 and August 31, 2013. Included in the analysis were patients 18 years of

Results

Ninety-five index cases were identified with a median age of 58.0 years (interquartile range 46-66 years) and a median IBD duration of 18 years (interquartile range 9.3-29.8 years) (Table 1). There was a male predominance (n = 65, 68.4%); most cases were identified among patients with a history of UC (n = 78, 82.1%) and pancolonic disease extent (n = 74, 77.9%). A history of PSC was reported in 23 patients (24.2%), and a family history of CRC was noted in 21 (22.3%). Additionally, current

Discussion

This study demonstrated that performing CE in IBD patients with a history of colorectal dysplasia on WLE identified new lesions likely missed on initial WLE examination, which were often amenable to endoscopic resection. Furthermore, continued surveillance with CE identified additional lesions amenable to endoscopic resection. The miss rate for colorectal dysplasia was lower with CE than with WLE in this high-risk population.

A meta-analysis of clinical studies supports the use of CE with

References (34)

  • T.A. Ullman et al.

    The fate of low grade dysplasia in ulcerative colitis

    Am J Gastroenterol

    (2002)
  • G.G. Konijeti et al.

    Cost-effectiveness analysis of chromoendoscopy for colorectal cancer surveillance in patients with ulcerative colitis

    Gastrointest Endosc

    (2014)
  • M.D. Rutter et al.

    Thirty-year analysis of a colonoscopic surveillance program for neoplasia in ulcerative colitis

    Gastroenterology

    (2006)
  • S. Eluri et al.

    Prevalence and characteristics of previously undetected (surprise) colorectal cancer in colectomy specimens among patients with inflammatory bowel disease [abstract]

    Gastroenterology

    (2014)
  • J.A. Eaden et al.

    The risk of colorectal cancer in ulcerative colitis: a meta-analysis

    Gut

    (2001)
  • T. Jess et al.

    Increased risk of intestinal cancer in Crohn's disease: a meta-analysis of population-based cohort studies

    Am J Gastroenterol

    (2005)
  • A. Kornbluth et al.

    Ulcerative colitis practice guidelines in adults: American College Of Gastroenterology, Practice Parameters Committee

    Am J Gastroenterol

    (2010)
  • Cited by (27)

    • Clear liquid diet before bowel preparation predicts successful chromoendoscopy in patients with inflammatory bowel disease

      2019, Gastrointestinal Endoscopy
      Citation Excerpt :

      CE has been shown to be superior to previous surveillance methods in a number of outcome categories. First, this technique generates an increased diagnostic yield for dysplasia compared with standard white-light endoscopy, both de novo and in patients with a history or previously identified premalignant lesions.9-11 Second, the use of CE is a more cost-effective method of surveillance.12

    • Dysplasia Surveillance in Inflammatory Bowel Disease

      2019, Clinical Gastrointestinal Endoscopy
    • Assessment of peri-polyp biopsy specimens of flat mucosa in patients with inflammatory bowel disease

      2018, Gastrointestinal Endoscopy
      Citation Excerpt :

      Such intervals for follow-up have not been defined in any prospective study, so including these risk factors can aid clinicians and patients in decision-making. The role for subsequent chromoendoscopy in higher risk patients has been studied, and the limited data do suggest an additional yield in performing dye spray colonoscopy in patients with prior dysplastic polypoid and nonpolypoid lesions.33,34 There is still a role for performing additional biopsy samples after polypectomy in patients with chronic colitis.

    • Endoscopy in inflammatory bowel disease: advances in dysplasia detection and management

      2017, Gastrointestinal Endoscopy
      Citation Excerpt :

      The recommendations were based on a meta-analysis of 8 studies from 5 different countries and include various study designs (2 randomized and 4 tandem studies comparing standard white-light endoscopy and chromoendoscopy and a tandem study evaluating high-definition white light). Several studies have subsequently been published, most of which were retrospective, and overall support the shift to continue toward targeted biopsy sampling for dysplasia detection.10,33-37 Marion et al36 highlighted the quality of a chromoendoscopy examination in a prospective longitudinal study.

    • Response:

      2016, Gastrointestinal Endoscopy
    View all citing articles on Scopus

    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.

    View full text