title: Incremental diagnostic yield of chromoendoscopy and outcomes in inflammatory bowel disease patients with a history of colorectal dysplasia on white-light endoscopy.
abstract: OBJECTIVE
  Chromoendoscopy (CE) identifies dysplastic lesions with a higher sensitivity than white-light endoscopy (WLE). The role of CE in the management of dysplasia on surveillance WLE in inflammatory bowel disease (IBD) remains unclear.
  
  
  METHODS
  A retrospective cohort of IBD patients with colorectal dysplasia on WLE who subsequently underwent CE between January 1, 2006 and August 31, 2013 was identified. Endoscopic and histologic findings were compared among the index WLE, first CE, and subsequent CE. Outcomes assessed included endoscopic lesion removal, surgery or repeat CE, and diagnosis of colorectal cancer.
  
  
  RESULTS
  Ninety-five index cases were identified. The median duration of IBD was 18 years (interquartile range 9.3-29.8); 78 patients had ulcerative colitis. Dysplasia was identified in 55 patients during the index WLE with targeted biopsies of 72 lesions. The first CE visualized dysplastic lesions in 50 patients, including 34 new lesions (not visualized on the index examination). Endoscopic resection was performed successfully of 43 lesions, most in the cecum/ascending colon (n = 20) with sessile morphology (n = 33). After the first CE, 14 patients underwent surgery that revealed 2 cases of colorectal cancer and 3 cases of high-grade dysplasia. Multiple CEs were performed in 44 patients. Of these, 20 patients had 34 visualized lesions, 26 of which were new findings.
  
  
  CONCLUSIONS
  Initial and subsequent CE performed in IBD patients with a history of colorectal dysplasia on WLE frequently identified new lesions, most of which were amenable to endoscopic treatment. These data support the use of serial CEs in this high-risk population.
authors.affiliation: Division of Gastroenterology and Hepatology, Mayo Clinic College of Medicine, Rochester, Minnesota, USA.
authors.forename: Parakkal
authors.initials: P
authors.lastname: Deepak
authors.affiliation: Mayo Medical School, Rochester, Minnesota, USA.
authors.forename: Gregory J
authors.initials: GJ
authors.lastname: Hanson
authors.affiliation: Division of Abdominal Imaging, Mayo Clinic College of Medicine, Rochester, Minnesota, USA.
authors.forename: Joel G
authors.initials: JG
authors.lastname: Fletcher
authors.affiliation: Division of Gastroenterology and Hepatology, Mayo Clinic College of Medicine, Rochester, Minnesota, USA.
authors.forename: William J
authors.initials: WJ
authors.lastname: Tremaine
authors.affiliation: Division of Gastroenterology and Hepatology, Mayo Clinic College of Medicine, Rochester, Minnesota, USA.
authors.forename: Darrell S
authors.initials: DS
authors.lastname: Pardi
authors.affiliation: Division of Gastroenterology and Hepatology, Mayo Clinic College of Medicine, Rochester, Minnesota, USA.
authors.forename: John B
authors.initials: JB
authors.lastname: Kisiel
authors.affiliation: Division of Gastroenterology and Hepatology, Mayo Clinic College of Medicine, Rochester, Minnesota, USA.
authors.forename: Kenneth W
authors.initials: KW
authors.lastname: Schroeder
authors.affiliation: Division of Gastroenterology and Hepatology, Mayo Clinic College of Medicine, Rochester, Minnesota, USA.
authors.forename: Louis M
authors.initials: LM
authors.lastname: Wong Kee Song
authors.affiliation: Division of Biomedical Statistics and Informatics, Mayo Clinic College of Medicine, Rochester, Minnesota, USA.
authors.forename: William S
authors.initials: WS
authors.lastname: Harmsen
authors.affiliation: Division of Gastroenterology and Hepatology, Mayo Clinic College of Medicine, Rochester, Minnesota, USA.
authors.forename: Edward V
authors.initials: EV
authors.lastname: Loftus
authors.affiliation: Division of Gastroenterology and Hepatology, Mayo Clinic College of Medicine, Rochester, Minnesota, USA.
authors.forename: David H
authors.initials: DH
authors.lastname: Bruining
mesh_terms: D000368:Aged; D003093:Colitis, Ulcerative / Q000000981:diagnostic imaging* / Q000473:pathology; D003106:Colon / Q000000981:diagnostic imaging / Q000473:pathology; D004396:Coloring Agents; D003424:Crohn Disease / Q000000981:diagnostic imaging* / Q000473:pathology; D000069916:Endoscopic Mucosal Resection; D016099:Endoscopy, Gastrointestinal / Q000379:methods*; D005260:Female; D006801:Humans; D007413:Intestinal Mucosa / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery; D008027:Light; D008297:Male; D008875:Middle Aged; D011230:Precancerous Conditions / Q000175:diagnosis* / Q000473:pathology / Q000601:surgery; D012007:Rectum / Q000000981:diagnostic imaging / Q000473:pathology; D012189:Retrospective Studies; D057832:Watchful Waiting / Q000379:methods*
chemical_list: D004396:Coloring Agents