title: White-Light or Narrow-Band Imaging Colonoscopy in Surveillance of Ulcerative Colitis: A Prospective Multicenter Study.
abstract: OBJECTIVE
  Early detection of neoplastic lesions is essential in patients with long-standing ulcerative colitis but the best technique of colonoscopy still is controversial.
  
  
  METHODS
  We performed a prospective multicenter study in patients with long-standing ulcerative colitis. Two colonoscopies were performed in each patient within 3 weeks to 3 months. In white-light (WL) colonoscopy, stepwise random biopsy specimens (4 biopsy specimens every 10 cm), segmental random biopsies (2 biopsy specimens in 5 segments), and targeted biopsy specimens were taken. In NBI colonoscopy, segmental and targeted biopsy specimens were taken. The sequence of WL and NBI colonoscopy was randomized.
  
  
  RESULTS
  In 36 of 159 patients enrolled (22.6%), 54 lesions with intraepithelial neoplasia (IN) were found (51 low-grade, 3 high-grade). In WL colonoscopy we found 11 IN in stepwise biopsy specimens, 4 in segmental biopsy specimens, and 15 in targeted biopsy specimens. In NBI colonoscopy 7 IN were detected in segmental biopsy specimens and 24 IN were detected in targeted biopsy specimens. Almost all IN were found with one technique alone (κ value of WL vs NBI, -0.86; P < .001). Statistically equivalent numbers of IN were found in NBI colonoscopy with targeted and segmental biopsy specimens as in WL colonoscopy with targeted and stepwise biopsy specimens, but with fewer biopsy specimens (11.9 vs 38.6 biopsy specimens, respectively; P < .001), and less withdrawal time was necessary (23 vs 13 min, respectively; P < .001).
  
  
  CONCLUSIONS
  Stepwise biopsy specimens are indispensable in WL colonoscopy. The combination of targeted and segmental biopsy specimens in the NBI technique is as sensitive as targeted together with stepwise biopsy specimens in WL colonoscopy, but requires fewer biopsy specimens and less time. The highest sensitivity should be reached by combining the WL and NBI techniques by switching between the modes.
authors.affiliation: Department of Internal Medicine, Evangelisches Krankenhaus Kalk, Cologne, Germany. Electronic address: l.leifeld@bernward-khs.de.
authors.forename: Ludger
authors.initials: L
authors.lastname: Leifeld
authors.affiliation: Division of Gastroenterology and Hepatology, Zurich University Hospital, Zurich, Switzerland.
authors.forename: Gerhard
authors.initials: G
authors.lastname: Rogler
authors.affiliation: Department of Internal Medicine IV, Jena University Hospital, Jena, Germany.
authors.forename: Andreas
authors.initials: A
authors.lastname: Stallmach
authors.affiliation: Department of Internal Medicine IV, Jena University Hospital, Jena, Germany.
authors.forename: Carsten
authors.initials: C
authors.lastname: Schmidt
authors.affiliation: Hospital for Internal Medicine I, Regensburg University Medical Center, Regensburg, Germany.
authors.forename: Ina
authors.initials: I
authors.lastname: Zuber-Jerger
authors.affiliation: St Marien-Krankenhaus, Frankfurt, Dessau, Germany.
authors.forename: Franz
authors.initials: F
authors.lastname: Hartmann
authors.affiliation: Department of Internal Medicine, Städtisches Klinikum Dessau, Dessau, Germany.
authors.forename: Mathias
authors.initials: M
authors.lastname: Plauth
authors.affiliation: Software Forga, Höhndorf, Germany.
authors.forename: Attyla
authors.initials: A
authors.lastname: Drabik
authors.affiliation: Institute of Pathology, University of Regensburg, Regensburg, Germany.
authors.forename: Ferdinand
authors.initials: F
authors.lastname: Hofstädter
authors.affiliation: Institute of Pathology, Cologne University Hospital, Cologne, Germany.
authors.forename: Hans Peter
authors.initials: HP
authors.lastname: Dienes
authors.affiliation: Department of Internal Medicine, Evangelisches Krankenhaus Kalk, Cologne, Germany.
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Kruis
mesh_terms: D000328:Adult; D001706:Biopsy; D003093:Colitis, Ulcerative / Q000150:complications*; D003110:Colonic Neoplasms / Q000175:diagnosis*; D003113:Colonoscopy / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D062048:Narrow Band Imaging / Q000379:methods*; D011446:Prospective Studies; D011897:Random Allocation; D012680:Sensitivity and Specificity
keywords: Cancer; Colonoscopy; Dysplasia; Inflammatory Bowel Disease; Narrow-Band Imaging; Ulcerative Colitis