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Dysplasia detection is similar between chromoendoscopy and high-definition white-light colonoscopy in inflammatory bowel disease patients: a US-matched case-control study

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International Journal of Colorectal Disease Aims and scope Submit manuscript

Abstract

Introduction

Inflammatory bowel disease (IBD) patients are at greater risk of developing colorectal cancer (CRC). Detection of precursor dysplasia is important for cancer prevention. Recent guidelines recommend dye chromoendoscopy (DCE) as the preferred method for dysplasia detection. Universal adoption of DCE is time-consuming and may limit endoscopy access. The benefit of universal application of the guidelines is unclear. We compared high-definition white-light colonoscopy (HD-WLC) with DCE for dysplasia detection in IBD patients.

Methods

We conducted a retrospective case-control study of adult IBD patients undergoing dysplasia surveillance between September 1, 2015, and February 1, 2020. DCE cases were matched to HD-WLC in a 1:1 ratio for gender, IBD diagnosis, and age. DCE patients were considered high risk for colorectal cancer by the referring provider.

Results

A total of 187 subjects were enrolled. Majority were males, were Caucasian, and had longstanding IBD (primarily ulcerative colitis). Baseline characteristics were similar between the two groups, except for history of surgery, duration of IBD, and history of dysplasia. There was no significant difference in dysplasia detection between DCE and HD-WLC (10.2% vs 6.7%, p = 0.39). More polyps were detected in the DCE arm compared with the HD-WLC group (1.35 vs 0.80, p = 0.018), but adenoma detection rate was not statistically different between the two groups (10.2% vs 9.0%, p = 0.31). Mean withdrawal time was longer in the DCE group (24.6 min vs 15.4, p < 0.001).

Conclusions

There were no differences in dysplasia detection using DCE compared with HD-WLC, although withdrawal times were longer with DCE.

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Author information

Authors and Affiliations

  1. Division of Gastroenterology & Hepatology, Department of Medicine, Pennsylvania State University Milton S. Hershey Medical Center, 500 University Drive, Hershey, PA, 17033, USA

    Kofi Clarke, Mitchell Kang, Venkata Subhash Gorrepati, Jonathan G. Stine, Andrew Tinsley, Emmanuelle Williams, Matthew Moyer & Matthew Coates

  2. Department of Public Health Sciences, Pennsylvania State University Milton S. Hershey Medical Center, Hershey, PA, USA

    Jonathan G. Stine

Authors
  1. Kofi Clarke
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  2. Mitchell Kang
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  3. Venkata Subhash Gorrepati
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  4. Jonathan G. Stine
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  5. Andrew Tinsley
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  6. Emmanuelle Williams
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  7. Matthew Moyer
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  8. Matthew Coates
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Corresponding author

Correspondence to Kofi Clarke.

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Conflict of interest

Dr Kofi Clarke: Consultant and research grant review—Pfizer; Speakers Bureau Educational Non-Branded presentations—ABBVie, Takeda, Janssen, Pfizer. Dr Andrew Tinsley: Speakers Bureau Educational Non-Branded presentations—ABBVie, Pfizer. Dr Emmanuelle Williams: Speakers Bureau Educational Non-Branded presentations—ABBVie, Pfizer. The other authors have no relevant financial or other conflicts of interest related to this study

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Study highlights

1) What is current knowledge

✓ Accurate detection of dysplasia is crucial for early colorectal cancer detection in patients with inflammatory bowel disease.

✓ Guidelines have suggested dye chromoendoscopy as the preferred method for dysplasia detection; however, its benefit in a real-world setting with challenges in implementation remains unknown.

2) What is new here

✓ Our study shows that there is no difference in dysplasia detection between chromoendoscopy and high-definition white-light colonoscopy.

✓ These findings support the growing evidence that implementing universal chromoendoscopy for dysplasia surveillance is costlier and time-consuming with little benefit in everyday IBD clinical care.

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Clarke, K., Kang, M., Gorrepati, V.S. et al. Dysplasia detection is similar between chromoendoscopy and high-definition white-light colonoscopy in inflammatory bowel disease patients: a US-matched case-control study. Int J Colorectal Dis 35, 2301–2307 (2020). https://doi.org/10.1007/s00384-020-03719-3

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  • DOI: https://doi.org/10.1007/s00384-020-03719-3

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