title: Comparison of high definition with standard white light endoscopy for detection of dysplastic lesions during surveillance colonoscopy in patients with colonic inflammatory bowel disease.
abstract: BACKGROUND
  Dysplasia in colonic inflammatory bowel disease (IBD) is often multifocal and flat. High-definition (HD) colonoscopy improves adenoma detection rates by improving the ability to detect subtle mucosal changes. The utility of HD colonoscopy in dysplasia detection in patients with IBD has not been reported so far. We aimed to compare the yield of dysplastic lesions detected by standard definition (SD) white light endoscopy with HD endoscopy.
  
  
  METHODS
  A retrospective cohort study of patients with long-standing (>7 years) colonic IBD undergoing surveillance colonoscopy at Nottingham University Hospital was studied between September 2008 and February 2010. Details of diagnosis, duration of disease, and outcomes of the colonoscopy were collected from the endoscopy database, electronic patient records, and patient notes.
  
  
  RESULTS
  There were 160 colonoscopies (101 ulcerative colitis [UC] and 59 Crohn's disease [CD]) in the SD group and 209 colonoscopies (147 UC and 62 CD) in the HD group. The groups were well matched for all demographic variables. Thirty-two dysplastic lesions (27 on targeted biopsy) were detected in 24 patients in the HD group and 11 dysplastic lesions (six on targeted biopsy) were detected in eight patients the SD group. The adjusted prevalence ratio of detecting any dysplastic lesion and dysplastic lesion on targeted biopsy was 2.21 (95% confidence interval [CI] 1.09-4.45) and 2.99 (95% CI 1.16-7.79), respectively, for HD colonoscopy.
  
  
  CONCLUSIONS
  HD colonoscopy improves targeted detection of dysplastic lesions during surveillance colonoscopy of patients with colonic IBD in routine clinical practice. Randomized controlled studies are required to confirm these findings.
authors.affiliation: Department of Gastroenterology and Leeds Institute of Molecular Medicine, St James University Hospital, Leeds, UK. venkat.subramanian@leedsth.nhs.uk
authors.forename: Venkataraman
authors.initials: V
authors.lastname: Subramanian
authors.forename: Vidyasagar
authors.initials: V
authors.lastname: Ramappa
authors.forename: Emmanouil
authors.initials: E
authors.lastname: Telakis
authors.forename: Jayan
authors.initials: J
authors.lastname: Mannath
authors.forename: Aida U
authors.initials: AU
authors.lastname: Jawhari
authors.forename: Christopher J
authors.initials: CJ
authors.lastname: Hawkey
authors.forename: Krish
authors.initials: K
authors.lastname: Ragunath
mesh_terms: D000368:Aged; D015331:Cohort Studies; D003093:Colitis, Ulcerative / Q000473:pathology*; D003106:Colon / Q000473:pathology*; D003110:Colonic Neoplasms / Q000473:pathology*; D003113:Colonoscopy / Q000379:methods*; D003424:Crohn Disease / Q000473:pathology*; D005260:Female; D006801:Humans; D007413:Intestinal Mucosa / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D016012:Poisson Distribution; D011230:Precancerous Conditions / Q000473:pathology*; D012044:Regression Analysis; D012189:Retrospective Studies