Chromoendoscopy with targeted biopsies is superior to white-light endoscopy for the long-term follow-up detection of dysplasia in ulcerative colitis patients: a multicenter randomized–controlled trial. (20th September 2020)

• Record Type: Journal Article
• Authors: Wan, Jian; Zhang, Qin; Liang, Shu-Hui; Zhong, Jie; Li, Jing-Nan; Ran, Zhi-Hua; Zhi, Fa-Chao; Wang, Xiao-Di; Zhang, Xiao-Lan; Wen, Zhong-Hui; Sheng, Jian-Qiu; Shi, Hua-Xiu; Mei, Qiao; Wu, Kai-Chun
• Is Part Of: Gastroenterology report. Volume 9:Number 1(2021)
• Page Start: 14
• Page End: 21
• Publication Date: 2020-09-20
• Subjects: ulcerative colitis -- dysplasia -- chromoendoscopy -- white-light endoscopy; Gastroenterology -- Periodicals; 616.33
• DOI: 10.1093/gastro/goaa028
• Languages: English
• ISSNs: 2052-0034

Abstract

Abstract: Background: Data from single-center experience or small sample-sized studies have shown that chromoendoscopy (CE) might be superior to white-light endoscopy (WLE) for dysplasia surveillance in ulcerative colitis (UC) patients. We performed a prospective randomized trial with a long-term follow-up to compare the detection rate of dysplasia among WLE with targeted biopsies (WLT), WLE with random biopsies (WLR), and dye-based CE with targeted biopsies (CET) in UC patients. Methods: Patients with long-standing UC were enrolled from 11 medical centers from March 2012 to December 2013 and randomized into three arms (WLT, WLR, and CET). Only high-definition endoscopy was used in all three groups. The patients were followed up by annual endoscopy with biopsies through December 2017. Results: With a median follow-up time of 55 months, a total of 122 patients with 447 colonoscopies were finally analysed in the per-protocol set: WLT ( n = 43), WLR ( n = 40), and CET ( n = 39). A total of 34 dysplastic lesions were found in 29 colonoscopies of 21 patients. WLR and CET could identify more colonoscopies that diagnosed dysplasia than WLT (8.1% and 9.7% vs 1.9%; P = 0.014 and 0.004, respectively). WLR obtained more biopsied samples than WLT and CET (16.4 ± 5.1 vs 4.3 ± 1.4 and 4.3 ± 1.4; both P < 0.001). During the second half of the follow-up (37 − 69 months), CET could identify more colonoscopies that diagnosed dysplasia than WLT (13.3% vs 1.6%, P = 0.015) and showed a trend for increasing the detection rate compared with WLR (13.3% vs 4.9%, P = 0.107). Conclusions: For a better outcome of cancer/dysplasia surveillance in patients with long-standing UC, CET appeared to be more effective than WLT and less tedious than WLR. CET was found to be particularly useful when a long-term (>3 years) follow-up was conducted for dysplasia surveillance. The trial was registered on www.chictr.org.cn (ChiCTR1900023689).