title: Chromoendoscopy Is More Effective Than Standard Colonoscopy in Detecting Dysplasia During Long-term Surveillance of Patients With Colitis.
abstract: OBJECTIVE
  Patients with colitis have an increased risk of colorectal cancer, compared with persons without colitis. Many studies have shown chromoendoscopy (CE) to be superior to standard methods of detecting dysplasia in patients with colitis at index examination. We performed a prospective, longitudinal study to compare standard colonoscopy vs CE in detecting dysplasia in patients with inflammatory bowel diseases in a surveillance program.
  
  
  METHODS
  We analyzed data from 68 patients (44 men, 24 women) diagnosed with ulcerative colitis (n = 55) or Crohn's disease (n = 13) at Mount Sinai Medical Center from September 2005 through October 2011. The patients were followed from June 2006 through October 2011 (median, 27.8 months); each patient was analyzed by random biopsy, targeted white light examination (WLE), and CE. Specimens were reviewed by a single blinded pathologist. The 3 methods were compared by using the generalized estimating equations method, and the odds ratios (ORs) for detection of dysplasia were calculated (primary outcome). Time to colectomy was analyzed by using the Cox model.
  
  
  RESULTS
  In the 208 examinations conducted, 44 dysplastic lesions were identified in 24 patients; 6 were detected by random biopsy, 11 by WLE, and 27 by CE. Ten patients were referred for colectomy, and no carcinomas were found. At any time during the study period, CE (OR, 5.4; 95% confidence interval [CI], 2.9-9.9) and targeted WLE (OR, 2.3; 95% CI, 1.0-5.3) were more likely than random biopsy analysis to detect dysplasia. CE was superior to WLE (OR, 2.4; 95% CI, 1.4-4.0). Patients identified as positive for dysplasia were more likely to need colectomy (hazard ratio, 12.1; 95% CI, 3.2-46.2).
  
  
  CONCLUSIONS
  In a prospective study of 68 patients with inflammatory bowel diseases, CE was superior to random biopsy or WLE analyses in detecting dysplasia in patients with colitis during an almost 28-month period. A negative result from CE examination was the best indicator of a dysplasia-free outcome, whereas a positive result was associated with earlier referral for colectomy.
authors.affiliation: The Henry D. Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, New York. Electronic address: james.marion@mssm.edu.
authors.forename: James F
authors.initials: JF
authors.lastname: Marion
authors.affiliation: The Henry D. Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, New York.
authors.forename: Jerome D
authors.initials: JD
authors.lastname: Waye
authors.affiliation: Division of Gastroenterology and Hepatobiliary Diseases, New York Medical College, Valhalla, New York.
authors.forename: Yuriy
authors.initials: Y
authors.lastname: Israel
authors.affiliation: The Henry D. Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, New York.
authors.forename: Daniel H
authors.initials: DH
authors.lastname: Present
authors.affiliation: Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, New York.
authors.forename: Maria
authors.initials: M
authors.lastname: Suprun
authors.affiliation: Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, New York.
authors.forename: Carol
authors.initials: C
authors.lastname: Bodian
authors.affiliation: Department of Pathology, Icahn School of Medicine at Mount Sinai, New York, New York.
authors.forename: Noam
authors.initials: N
authors.lastname: Harpaz
authors.affiliation: The Henry D. Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, New York.
authors.forename: Mark
authors.initials: M
authors.lastname: Chapman
authors.affiliation: The Henry D. Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, New York.
authors.forename: Steven
authors.initials: S
authors.lastname: Itzkowitz
authors.affiliation: Division of Gastroenterology, University of Miami, Miami, Florida.
authors.forename: Maria T
authors.initials: MT
authors.lastname: Abreu
authors.affiliation: The Henry D. Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, New York.
authors.forename: Thomas A
authors.initials: TA
authors.lastname: Ullman
authors.affiliation: Department of Pathology and the Institute for Translational Epidemiology, Icahn School of Medicine at Mount Sinai, New York, New York.
authors.forename: Russell B
authors.initials: RB
authors.lastname: McBride
authors.affiliation: The Henry D. Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, New York.
authors.forename: James
authors.initials: J
authors.lastname: Aisenberg
authors.affiliation: The Henry D. Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, New York.
authors.forename: Lloyd
authors.initials: L
authors.lastname: Mayer
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001706:Biopsy; D003092:Colitis / Q000150:complications*; D015179:Colorectal Neoplasms / Q000175:diagnosis*; D004724:Endoscopy / Q000379:methods*; D005260:Female; D006801:Humans; D015212:Inflammatory Bowel Diseases / Q000150:complications*; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D055815:Young Adult
keywords: CRC; Colon Cancer; Early Detection; IBD