title: Confocal chromoscopic endomicroscopy is superior to chromoscopy alone for the detection and characterisation of intraepithelial neoplasia in chronic ulcerative colitis.
abstract: BACKGROUND
  The diagnosis of intraepithelial neoplasia is pivotal for ongoing clinical management decisions in ulcerative colitis. Previous studies have compared the diagnostic yield of endomicroscopy with conventional "white light" endoscopy and hence the overall objective increase of endomicroscopy targeted biopsies as compared to chromoscopy guided alone is not apparent.
  
  
  OBJECTIVE
  We performed a prospective randomised controlled study to compare the diagnostic yield of intraepithelial neoplasia and cancer in patients undergoing ulcerative colitis screening using chromoscopy assisted endomicroscopy (group A) versus pan-colonic chromoscopy assisted colonoscopy (group B).
  
  
  METHODS
  Patients were randomised in a 1:1 ratio to undergo screening colonoscopy using either chromoscopic endomicroscopy or chromoscopy alone with targeted biopsies. Circumscribed lesions were characterised using endomicroscopy and chromoscopy with pit pattern analysis. Targeted biopsies in addition to conventional 10 cm quadrantic biopsies were taken. Primary outcome addressed the number of intraepithelial neoplasias detected in each group.
  
  
  RESULTS
  Endomicroscopy targeted biopsies significantly increased the yield of intraepithelial neoplasia as compared to pan-chromoscopy and biopsy alone (p<0.001) and also increased the yield of high-grade dysplastic lesions (p<0.001). Endomicroscopy targeted biopsies increased the diagnostic yield of intraepithelial neoplasia as compared to chromoscopy guided biopsies alone by 2.5-fold.
  
  
  CONCLUSIONS
  This is the first randomised controlled study to show the true clinical benefit of endomicroscopy for the in vivo detection and characterisation of intraepithelial neoplasia in chronic ulcerative colitis surveillance colonoscopy. Endomicroscopy with targeted biopsy may potentially be the "gold standard" for the detection of intraepithelial neoplasia in ulcerative colitis.
authors.affiliation: Gastroenterology and Liver Unit at the Royal Hallamshire Hospital Sheffield/The Sheffield Hallam University Academy of Endomicroscopy, Sheffield, UK. p.hurlstone@shef.ac.uk
authors.forename: D P
authors.initials: DP
authors.lastname: Hurlstone
authors.forename: R
authors.initials: R
authors.lastname: Kiesslich
authors.forename: M
authors.initials: M
authors.lastname: Thomson
authors.forename: R
authors.initials: R
authors.lastname: Atkinson
authors.forename: S S
authors.initials: SS
authors.lastname: Cross
mesh_terms: D001706:Biopsy; D002278:Carcinoma in Situ / Q000175:diagnosis / Q000473:pathology*; D003093:Colitis, Ulcerative / Q000150:complications*; D003110:Colonic Neoplasms / Q000175:diagnosis / Q000473:pathology*; D003113:Colonoscopy / Q000379:methods; D005260:Female; D019793:Fluorescein; D006801:Humans; D008297:Male; D008751:Methylene Blue; D018613:Microscopy, Confocal / Q000379:methods; D011230:Precancerous Conditions / Q000175:diagnosis / Q000473:pathology*; D011446:Prospective Studies; D012680:Sensitivity and Specificity
chemical_list: D008751:Methylene Blue; D019793:Fluorescein