In a new study, researchers reported that chromoendoscopy is a more effective diagnostic and monitoring method for detection of dysplasia in long-term surveillance of inflammatory bowel disease (IBD). The article, titled “Chromoendoscopy is More Effective Than Standard Colonoscopy in Detecting Dysplasia During Long-term Surveillance of Patients with Colitis,” was published in the journal Clinical Gastroenterology and Hepatology.
IBD is a known risk factor for colorectal cancer, a fact that further increases the importance of effective surveillance of these patients. Previous studies have shown that chromoendoscopy, a method that uses stains to highlight changes in the digestive mucosa during endoscopy, is superior to standard surveillance techniques — such as white light colonoscopy, non-targeted biopsies, targeted sampling, and removal of lesions — in the identification of dysplasia or malignant changes that could indicate an increased risk for colorectal cancer. Despite the growing consensus favoring chromoendoscopy, the efficacy of the method in the long term has not been fully explored.
To evaluate the technique’s efficacy in long-term surveillance, the researchers analyzed data from 68 patients diagnosed with ulcerative colitis (55) or Crohn’s disease (13) at Mount Sinai Medical Center. The patients had long-term follow-up, from June 2006 through October 2011, in which they were examined through random biopsy, targeted white-light examination (WLE), and chromoendoscopy to compare the efficacy of the three methods.
Results from the 208 examinations showed that 44 dysplastic lesions were identified in 24 patients. Six of such lesions were identified by random biopsy, 11 by WLE, and 27 by chromoendoscopy. Statistical analyses further demonstrated that, at any time in the study, chromoendoscopy and WLE were more likely than random biopsy analysis to detect dysplasia, with chromoendoscopy being superior to WLE. Positive dysplasia results were associated with earlier referral for colectomy.
Study leader Dr. James F. Marion, professor of Medicine at Icahn School of Medicine at Mount Sinai, said in a press release, “Despite the abundant evidence supporting improved dysplasia detection in patients with IBD through chromoendoscopy screening and its incorporation into our guidelines, many gastroenterologists continue to rely on expensive random biopsies for detection of dysplasia and colorectal cancer. We hope these long-term findings resonate throughout the GI community and prompt screening changes, thus improving patient outcomes.”
He continued, “Chromoendoscopy is an inexpensive, easy-to-learn technique that allows us to manage our patients without surgery. Our current guidelines will need to be revisited.”