High-definition colonoscopy sufficient for IBD surveillance

Last Updated: 2017-12-15

By Will Boggs MD

NEW YORK (Reuters Health) - High-definition colonoscopy is as effective as more advanced techniques, including dye spraying chromoendoscopy (DCE) and virtual chromoendoscopy (VCE), for detecting colonic neoplastic lesions during inflammatory bowel disease (IBD) surveillance, according to results from a noninferiority trial.

"Currently dye spraying chromoendoscopy is recommended for optimal detection of neoplastic lesions at colonoscopy," said Dr. Marietta Iacucci from the University of Calgary, in Canada, and the University of Birmingham, in the UK.

"This randomized study has shown that colonoscopy without dye spraying is equally effective in detecting neoplastic lesions using modern high-resolution colonoscopies, thus saving considerable time and expense," she told Reuters Health by email.

Regular surveillance is considered necessary because of the increased risk of developing colorectal cancer in individuals with long-standing IBD, but it remains unclear which method is best for detecting colorectal dysplasia.

Dr. Iacucci and colleagues investigated the detection rates of neoplastic lesions in IBD patients with long-standing colitis, comparing high-definition (HD) colonoscopy alone (90 patients), VCE (90 patients), and DCE (90 patients), in their randomized noninferiority trial.

VCE was noninferior to DCE, and HD colonoscopy was noninferior to DCE and VCE for detecting dysplasia and adenocarcinoma and for all lesions, they report in the American Journal of Gastroenterology, online November 14.

Detection rates were similar among the three arms of the study for all lesions, including sessile serrated adenoma, tubular adenoma in non-colitic areas, dysplasia, and adenocarcinoma.

Procedure duration was similar across the three groups.

Factors significantly predictive of dysplasia included endoscopic Kudo pit pattern and localization of lesions in the right colon.

"If confirmed by other studies (another study is about to report the same), this will completely change the practice of surveillance colonoscopy in colitis," Dr. Iacucci said.

SOURCE: http://bit.ly/2zeJAgc

Am J Gastroenterol 2017.