Real-life chromoendoscopy for neoplasia detection and characterisation in long-standing IBD.
Outside clinical trials, the effectiveness of chromoendoscopy (CE) for long-standing IBD surveillance is controversial. We aimed to assess the effectiveness of CE for neoplasia detection and characterisation, in real-life.



From June 2012 to 2014, patients with IBD were prospectively included in a multicentre cohort study. Each colonic segment was evaluated with white light followed by 0.4% indigo carmine CE. Specific lesions' features were recorded. Optical diagnosis was assessed. Dysplasia detection rate between expert and non-expert endoscopists and learning curve were ascertained.



Ninety-four (15.7%) dysplastic (1 cancer, 5 high-grade dysplasia, 88 low-grade dysplasia) and 503 (84.3%) non-dysplastic lesions were detected in 350 patients (47% female; mean disease duration: 17 years). Colonoscopies were performed with standard definition (41.5%) or high definition (58.5%). Dysplasia miss rate with white light was 40/94 (57.4% incremental yield for CE). CE-incremental detection yield for dysplasia was comparable between standard definition and high definition (51.5% vs 52.3%, p=0.30). Dysplasia detection rate was comparable between expert and non-expert (18.5% vs 13.1%, p=0.20). No significant learning curve was observed (8.2% vs 14.2%, p=0.46). Sensitivity, specificity, and positive and negative predictive values for dysplasia optical diagnosis were 70%, 90%, 58% and 94%, respectively. Endoscopic characteristics predictive of dysplasia were: proximal location, loss of innominate lines, polypoid morphology and Kudo pit pattern III-V.



CE presents a high diagnostic yield for neoplasia detection, irrespectively of the technology and experience available in any centre. In vivo, CE optical diagnosis is highly accurate for ruling out dysplasia, especially in expert hands. Lesion characteristics can aid the endoscopist for in situ therapeutic decisions.



NCT02543762.
Gastroenterology Department, Hospital Clínic de Barcelona, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Institut d'Investigacions Biomediques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Barcelona, Spain.
Sabela
S
Carballal
Gastroenterology Department, Hospital Universitario de Bellvitge, Hospitalet de Llobregat, Barcelona, Spain.
Sandra
S
Maisterra
Gastroenterology Department, Hospital Universitari Dr. Peset, Valencia, Spain.
Antonio
A
López-Serrano
Gastroenterology Department, Hospital Universitario de Canarias, La Laguna, Spain.
Antonio Z
AZ
Gimeno-García
Gastroenterology Department, Hospital Puerta del Hierro, Madrid, Spain.
María Isabel
MI
Vera
Gastroenterology Department, Hospital Universitario 12 de Octubre, Madrid, Spain.
José Carlos
JC
Marín-Garbriel
Gastroenterology Department, Hospital Universitario 12 de Octubre, Madrid, Spain.
José
J
Díaz-Tasende
Gastroenterology Department, Hospital del Mar, Barcelona, Spain.
Lucía
L
Márquez
Gastroenterology Department, Hospital del Mar, Barcelona, Spain.
Marco Antonio
MA
Álvarez
Digestive Disease Section, Hospital Universitario de Móstoles, Madrid, Spain.
Luis
L
Hernández
Gastroenterology Department, Complexo Hospitalario Universitario de Vigo, Instituto de Investigación Biomédica. Estructura Organizativa de Xestión Integrada de Vigo, Vigo, Spain.
Luisa
L
De Castro
Gastroenterology Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.
Jordi
J
Gordillo
Gastroenterology Department, Althaia, Xarxa Assistencial Universitària de Manresa, Universitat Internacional de Catalunya, Barcelona, Spain.
Ignasi
I
Puig
Gastroenterology Department, Complexo Hospitalario Universitario de Ourense, Ourense, Spain.
Pablo
P
Vega
Gastroenterology Department, Hospital Universitario de La Fe, Valencia, Spain.
Marco
M
Bustamante-Balén
Gastroenterology Department, Hospital Comarcal de Calella, Barcelona, Spain.
Juan
J
Acevedo
Gastroenterology Department, Hospital Ramón y Cajal, Madrid, Spain.
Beatriz
B
Peñas
Gastroenterology Department, Hospital Clínic de Barcelona, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Institut d'Investigacions Biomediques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Barcelona, Spain.
María
M
López-Cerón
Gastroenterology Department, Hospital Clínic de Barcelona, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Institut d'Investigacions Biomediques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Barcelona, Spain.
Elena
E
Ricart
Pathology Department, Centre de Diagnostic Biomèdic (CDB), Hospital Clínic, University of Barcelona and Banc de Tumors-Biobanc Clinic-IDIBAPS-XBTC, Barcelona, Catalonia, Spain.
Miriam
M
Cuatrecasas
Pathology Department, Centre de Diagnostic Biomèdic (CDB), Hospital Clínic, University of Barcelona and Banc de Tumors-Biobanc Clinic-IDIBAPS-XBTC, Barcelona, Catalonia, Spain.
Mireya
M
Jimeno
Gastroenterology Department, Hospital Clínic de Barcelona, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Institut d'Investigacions Biomediques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Barcelona, Spain.
María
M
Pellisé
D000328:Adult; D000368:Aged; D002983:Clinical Competence; D003093:Colitis, Ulcerative / Q000150:complications; D003113:Colonoscopy / Q000193:education / Q000379:methods* / Q000592:standards; D015179:Colorectal Neoplasms / Q000175:diagnosis* / Q000209:etiology / Q000473:pathology; D004396:Coloring Agents; D003424:Crohn Disease / Q000150:complications; D055088:Early Detection of Cancer / Q000379:methods*; D004502:Education, Medical, Continuing; D005260:Female; D006801:Humans; D007203:Indigo Carmine; D015212:Inflammatory Bowel Diseases / Q000150:complications*; D059032:Learning Curve; D008297:Male; D008875:Middle Aged; D011230:Precancerous Conditions / Q000175:diagnosis* / Q000209:etiology / Q000473:pathology; D011446:Prospective Studies
D004396:Coloring Agents; D007203:Indigo Carmine
COLONOSCOPY; COLORECTAL CANCER; DYSPLASIA; INFLAMMATORY BOWEL DISEASE; ULCERATIVE COLITIS