Article Report

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

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Abstract

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.

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Acknowledgements

Dr. Miriam Fort Gasia contributed to the research recruitment and is acknowledged for her contribution, ClinicalTrials.gov number: NCT02098798. MI is funded by the NIHR Birmingham Biomedical Research Centre at the University Hospitals Birmingham NHS Foundation Trust and the University of Birmingham. The views expressed are those of the author(s) and not necessarily those of the NHS, the NIHR or the Department of Health.

Author information

Affiliations

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

    • Marietta Iacucci
    • , Gilaad G Kaplan
    • , Remo Panaccione
    • , Oluseyi Akinola
    • , Yvette Leung
    • , Kerri L Novak
    • , Cynthia H Seow
    •  & Subrata Ghosh
  2. Division of Gastroenterology & Institute of Translational Medicine, NIHR Biomedical Research Center, Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK

    • Marietta Iacucci
    •  & Subrata Ghosh
  3. Department of Community Health Sciences, Clinical Research Unit, Cumming School of Medicine, University of Calgary, Calgary, Canada

    • Brendan Cord Lethebe
    • , Mark Lowerison
    •  & Cynthia H Seow
  4. Department of Pathology, University of Calgary, Cumming School of Medicine, Calgary, Canada

    • Stefan Urbanski
    • , Parham Minoo
    •  & Xianyong Gui

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Competing interests

Guarantor of the article: Marietta Iacucci, MD, PhD.

Specific author contributions: Study design and idea: MI, SG. Data Acquisition: MI, AO, SG, SU, PM, XS, GGK, RP, SG, KN, CHS, YL. Analysis of data: MI, AO, SG, BCL, MLL, GGK. Writing of manuscript: MI, SG.GGK. Revision of manuscript: MI, SG, RP, AO, XG, SU, PM, GGK, KN, YL, CHS, BCL, MLL.

Financial support: No financial support was provided for this manuscript.

Potential competing interests: M. Iacucci received an unrestricted research grant from Pentax USA (2013–2016) and speaker’s fee from Pentax (2016). The remaing authors declare no conflict of interest.

Corresponding author

Correspondence to Marietta Iacucci.

Appendices

Appendix 1

Table 6: Baseline characteristics and endoscopic features of colonic neoplastic lesions