High-Definition Chromoendoscopy Versus High-Definition White Light Colonoscopy for Neoplasia Surveillance in Ulcerative Colitis: A Randomized Controlled Trial

• Published in: The American journal of gastroenterology Vol. 114; no. 10; pp. 1642 - 1648
• Main Authors: Yang, Dong-Hoon, Park, Soo Jung, Kim, Hyun-Soo, Park, Young Sook, Park, Dong Il, Lee, Kang-Moon, Jung, Sung-Ae, Choi, Chang Hwan, Koo, Ja Seol, Cheon, Jae Hee, Yang, Suk-Kyun, Kim, Won Ho, Kim, Jihun, Kim, Hogeun, Ryan Choi, Chang-Ho
• Format: Journal Article
• Language: English
• Published: United States Wolters Kluwer 01-10-2019
• Subjects: Adult; Aged; Biopsy; Colitis, Ulcerative - complications; Colitis, Ulcerative - diagnostic imaging; Colitis, Ulcerative - pathology; Colon - diagnostic imaging; Colon - pathology; Colonoscopy - methods; Color; Colorectal Neoplasms - diagnosis; Colorectal Neoplasms - etiology; Colorectal Neoplasms - pathology; Coloring Agents - administration & dosage; Early Detection of Cancer - methods; Female; Humans; Intestinal Mucosa - diagnostic imaging; Intestinal Mucosa - pathology; Light; Male; Mass Screening - methods; Middle Aged; Prospective Studies; Republic of Korea; Young Adult; Republic of Korea
• ISSN: 0002-9270; 1572-0241
• DOI: 10.14309/ajg.0000000000000341

Although chromoendoscopy is currently the recommended mode of surveillance in patients with long-standing ulcerative colitis, it is technically challenging and requires a long procedure time. The aim of this study was to compare the dysplasia detection rate of high-definition white light endoscopy with random biopsy (HDWL-R) vs high-definition chromoendoscopy with targeted biopsy (HDCE-T).
This was a multicenter, prospective randomized controlled trial involving 9 tertiary teaching hospitals in South Korea. A total of 210 patients with long-standing ulcerative colitis were randomized to undergo either the HDWL-R group (n = 102) or HDCE-T group (n = 108). The detection rates of colitis-associated dysplasia (CAD) or all colorectal neoplasia from each trial arm were compared.
There was no significant difference in the CAD detection rate between HDCE-T and HDWL-R groups (4/102, 3.9% vs 6/108, 5.6%, P = 0.749). However, HDCE-T showed a trend toward improved colorectal neoplasia detection compared with HDWL-R (21/102, 20.6% vs 13/108, 12.0%, P = 0.093). The median (range) time for colonoscopy withdrawal between the 2 groups was similar (17.6 [7.0-43.3] minutes vs 16.5 [6.3-38.1] minutes; P=0.212; for HDWL-R and HDCE-T, respectively). The total number of biopsies was significantly larger in the HDWL-R group (34 [12-72]) compared with the HDCE-T group (9 [1-20]; P < 0.001).
On the basis of our prospective randomized controlled trial, HDCE-T was not superior to HDWL-R for detecting CADs.