title: Are random biopsies still useful for the detection of neoplasia in patients with IBD undergoing surveillance colonoscopy with chromoendoscopy?
abstract: Colonoscopy with pan-chromoendoscopy (CE) is superior to standard colonoscopy in detecting neoplasia in patients with IBD. Performing random biopsies in unsuspicious mucosa after CE remains controversial.
  
  
  
  Consecutive patients with IBD who underwent surveillance colonoscopy using CE were prospectively included. The standardised procedure used CE, performed targeted biopsies or endoscopic resection on suspicious lesions and then quadrant random biopsies every 10 cm. A panel of five expert pathologists reviewed histological slides with dysplasia. Logistic regression model was used to evidence the factors associated with neoplasia in any or in random biopsies.
  
  
  
  1000 colonoscopes were performed in 1000 patients (495 UC, 505 Crohn's colitis). In 82 patients, neoplasia was detected from targeted biopsies or removed lesions, and among them dysplasia was detected also by random biopsies in 7 patients. Importantly, in 12 additional patients dysplasia was only detected by random biopsies. Overall, 140 neoplastic sites were found in 94 patients, 112 (80%) from targeted biopsies or removed lesions and 28 (20%) by random biopsies. The yield of neoplasia by random biopsies only was 0.2% per-biopsy (68/31 865), 1.2% per-colonoscopy (12/1000) but 12.8% per-patient with neoplasia (12/94). Dysplasia detected by random biopsies was associated with a personal history of neoplasia, a tubular appearing colon and the presence of primary sclerosing cholangitis (PSC).
  
  
  
  Despite their low yield, random biopsies should be performed in association with CE in patients with IBD with a personal history of neoplasia, concomitant PSC or a tubular colon during colonoscopy.
  
  
  
  IRB 001508, Paris 7 University.
authors.affiliation: Gastroenterology Department, Lyon Sud Hospital, Pierre Bénite, France.
authors.forename: Driffa
authors.initials: D
authors.lastname: Moussata
authors.affiliation: Gastroenterology Department, Saint-Louis Hospital, Paris, France.
authors.forename: Matthieu
authors.initials: M
authors.lastname: Allez
authors.affiliation: Pathology Department, Beaujon Hospital, Clichy, France.
authors.forename: Dominique
authors.initials: D
authors.lastname: Cazals-Hatem
authors.affiliation: Gastroenterology Department, Beaujon Hospital, Clichy, France.
authors.forename: Xavier
authors.initials: X
authors.lastname: Treton
authors.affiliation: Gastroenterology Department, Bordeaux Hospital, Pessac, France.
authors.forename: David
authors.initials: D
authors.lastname: Laharie
authors.affiliation: Gastroenterology Department, INSERM U1113 and Hautepierre Hospital, Strasbourg, France.
authors.forename: Jean-Marie
authors.initials: JM
authors.lastname: Reimund
authors.affiliation: Pathology Department, Saint-Louis Hospital, Paris, France.
authors.forename: Philippe
authors.initials: P
authors.lastname: Bertheau
authors.affiliation: Gastroenterology Department, CIC Inserm 1413, Nantes University, Nantes, France.
authors.forename: Arnaud
authors.initials: A
authors.lastname: Bourreille
authors.affiliation: Pathology Department, Lariboisière Hospital, Paris, France.
authors.forename: Anne
authors.initials: A
authors.lastname: Lavergne-Slove
authors.affiliation: Hepato-Gastroenterology Department, Robert Debre University Hospital, Reims, France.
authors.forename: Hedia
authors.initials: H
authors.lastname: Brixi
authors.affiliation: Gastroenterology Department, Claude Huriez Hospital, Lille, France.
authors.forename: Julien
authors.initials: J
authors.lastname: Branche
authors.affiliation: Gastroenterology Department, Saint-Louis Hospital, Paris, France.
authors.forename: Jean-Marc
authors.initials: JM
authors.lastname: Gornet
authors.affiliation: Gastroenterology Department, Beaujon Hospital, Clichy, France.
authors.forename: Carmen
authors.initials: C
authors.lastname: Stefanescu
authors.affiliation: Gastroenterology Department, Rangueil Hospital, Toulouse, France.
authors.forename: Jacques
authors.initials: J
authors.lastname: Moreau
authors.affiliation: Hepatology Department, Saint-Antoine Hospital, Paris, France.
authors.forename: Philippe
authors.initials: P
authors.lastname: Marteau
authors.affiliation: Gastroenterology Department, Bichat Claude Bernard Hospital, Paris, France.
authors.forename: Anne-Laure
authors.initials: AL
authors.lastname: Pelletier
authors.affiliation: Gastroenterology Department, Bicêtre Hospital, Le Kremlin-Bicêtre, France.
authors.forename: Franck
authors.initials: F
authors.lastname: Carbonnel
authors.affiliation: Gastroenterology Department, Saint-Antoine Hospital, Paris, France.
authors.forename: Philippe
authors.initials: P
authors.lastname: Seksik
authors.affiliation: Hepato-Gastroenterology Department, Institut Mutualiste Montsouris, Paris, France.
authors.forename: Marion
authors.initials: M
authors.lastname: Simon
authors.affiliation: Pathology Department, Saint-Antoine Hospital, Paris, France.
authors.forename: Jean-François
authors.initials: JF
authors.lastname: Fléjou
authors.affiliation: Gastroenterology Department, Icahn School of Medicine Mount Sinai, New York, USA.
authors.forename: Jean-Fréderic
authors.initials: JF
authors.lastname: Colombel
authors.affiliation: Gastroenterology Department, Lyon Sud Hospital, Pierre Bénite, France.
authors.forename: Anne-Laure
authors.initials: AL
authors.lastname: Charlois
authors.affiliation: Gastroenterology Department, University Hospital, Saint Etienne, France.
authors.forename: Xavier
authors.initials: X
authors.lastname: Roblin
authors.affiliation: Gastroenterology Department, Lyon Sud Hospital, Pierre Bénite, France.
authors.forename: Stéphane
authors.initials: S
authors.lastname: Nancey
authors.affiliation: Gastroenterology Department, Beaujon Hospital, Clichy, France.
authors.forename: Yoram
authors.initials: Y
authors.lastname: Bouhnik
authors.affiliation: Pathology Department, Lyon Sud Hospital, Pierre Bénite, France.
authors.forename: Françoise
authors.initials: F
authors.lastname: Berger
authors.affiliation: Gastroenterology Department, Lyon Sud Hospital, Pierre Bénite, France.
authors.forename: Bernard
authors.initials: B
authors.lastname: Flourié
mesh_terms: D000328:Adult; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use; D001706:Biopsy / Q000379:methods; D003093:Colitis, Ulcerative / Q000150:complications; D003113:Colonoscopy / Q000379:methods*; D015179:Colorectal Neoplasms / Q000175:diagnosis* / Q000601:surgery; D003424:Crohn Disease / Q000150:complications; D005260:Female; D005500:Follow-Up Studies; D005602:France; D005762:Gastroenterology; D006801:Humans; D007089:Image Enhancement / Q000379:methods*; D015212:Inflammatory Bowel Diseases / Q000150:complications* / Q000188:drug therapy / Q000601:surgery; D008297:Male; D019804:Mesalamine / Q000627:therapeutic use; D008875:Middle Aged; D062048:Narrow Band Imaging; D011159:Population Surveillance / Q000379:methods; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012680:Sensitivity and Specificity
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal; D019804:Mesalamine
keywords: COLONOSCOPY; COLORECTAL NEOPLASIA; ENDOSCOPIC PROCEDURES; IBD