title: Surveillance in ulcerative colitis: is chromoendoscopy-guided endomicroscopy always better than conventional colonoscopy? A randomized trial.
abstract: BACKGROUND
  Ulcerative colitis (UC) is associated with an increased risk of colorectal cancer. Chromoendoscopy showed superiority to conventional colonoscopy (CC) in surveillance studies including high-risk patients. We aimed to compare chromoendoscopy-guided endomicroscopy (CGE) with CC for intraepithelial neoplasia (IN) detection in patients with longstanding UC without primary sclerosing cholangitis and/or history of IN.
  
  
  METHODS
  One hundred sixty-two patients with longstanding (≥ 8 yr) distal/extensive UC and without primary sclerosing cholangitis and/or history of IN were prospectively randomized to undergo CGE (group A) or CC (group B). Seventeen patients were excluded. In group A (n = 72), circumscribed lesions highlighted by pan-chromoendoscopy were evaluated by endomicroscopy, and targeted biopsy/polypectomy was performed. In group B (n = 73), 4 random biopsies every 10 cm and targeted biopsy/polypectomy of detected lesions were performed.
  
  
  RESULTS
  Thirteen IN, all low grade, were detected: 7 IN in group A and 6 in group B (P > 0.05), distributed, respectively, by 6 and 4 patients (P > 0.05). Significantly, more biopsies were performed in group B (4.7 ± 4.9 versus 36.0 ± 6.2, P < 0.001), and the per-biopsy yield of IN was higher in group A (1/48 versus 1/438, P < 0.001). Examination time was 61.5 ± 15.6 minutes in group A and 40.7 ± 8.7 minutes in group B (P < 0.001). The IN detection by endomicroscopy revealed: sensitivity = 85.7%, specificity = 97.9%, positive predictive value = 75.0%, and negative predictive value = 98.9%.
  
  
  CONCLUSIONS
  CGE does not improve the detection of IN in the endoscopic screening of patients with longstanding UC without primary sclerosing cholangitis and/or history of IN. CGE takes longer than CC, but it decreases the number of biopsies performed and significantly increases the per-biopsy yield of IN. Endomicroscopy is an accurate tool for IN detection.
authors.affiliation: *Department of Gastroenterology, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal; †Center of Gastroenterology, University of Coimbra, Coimbra, Portugal; ‡Department of Pathology, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal; and §Department of Gastroenterology, Centro Hospitalar Leiria-Pombal, Leiria, Portugal.
authors.forename: Paulo
authors.initials: P
authors.lastname: Freire
authors.forename: Pedro
authors.initials: P
authors.lastname: Figueiredo
authors.forename: Ricardo
authors.initials: R
authors.lastname: Cardoso
authors.forename: Maria M
authors.initials: MM
authors.lastname: Donato
authors.forename: Manuela
authors.initials: M
authors.lastname: Ferreira
authors.forename: Sofia
authors.initials: S
authors.lastname: Mendes
authors.forename: Mário R
authors.initials: MR
authors.lastname: Silva
authors.forename: Augusta
authors.initials: A
authors.lastname: Cipriano
authors.forename: Ana M
authors.initials: AM
authors.lastname: Ferreira
authors.forename: Helena
authors.initials: H
authors.lastname: Vasconcelos
authors.forename: Francisco
authors.initials: F
authors.lastname: Portela
authors.forename: Carlos
authors.initials: C
authors.lastname: Sofia
mesh_terms: D000328:Adult; D002278:Carcinoma in Situ / Q000175:diagnosis* / Q000209:etiology; D003093:Colitis, Ulcerative / Q000150:complications* / Q000473:pathology; D003110:Colonic Neoplasms / Q000175:diagnosis* / Q000209:etiology; D003113:Colonoscopy; D004396:Coloring Agents; D055088:Early Detection of Cancer; D004724:Endoscopy / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008751:Methylene Blue; D018613:Microscopy, Confocal; D008875:Middle Aged; D011230:Precancerous Conditions / Q000175:diagnosis* / Q000209:etiology; D011379:Prognosis; D011446:Prospective Studies
chemical_list: D004396:Coloring Agents; D008751:Methylene Blue