Chromoscopy-guided endomicroscopy increases the diagnostic yield of intraepithelial neoplasia in ulcerative colitis
- PMID: 17383417
- DOI: 10.1053/j.gastro.2007.01.048
Chromoscopy-guided endomicroscopy increases the diagnostic yield of intraepithelial neoplasia in ulcerative colitis
Abstract
Background and aims: Because of the large number of biopsy specimens, surveillance colonoscopy in ulcerative colitis (UC) is currently time consuming and significant flat lesions still may be missed. In this study we assessed the value of combined chromoscopy and endomicroscopy for the diagnosis of intraepithelial neoplasias in a randomized controlled trial.
Methods: A total of 161 patients with long-term UC in clinical remission were randomized at a 1:1 ratio to undergo conventional colonoscopy or chromoscopy with endomicroscopy. Eight patients were excluded because of insufficient bowel preparation. In the conventional colonoscopic group (n = 73), random biopsy examinations and targeted biopsy examinations were performed. In the endomicroscopy group (n = 80), circumscribed mucosal lesions were identified by chromoscopy and evaluated for targeted biopsy examination by endomicroscopy. The primary outcome analysis was based on the detection of neoplasias.
Results: By using chromoscopy with endomicroscopy, 4.75-fold more neoplasias could be detected (P = .005) than with conventional colonoscopy, although 50% fewer biopsy specimens (P = .008) were required. If only circumscribed lesions would have been biopsied in the first group, the total number of biopsy specimens could have been reduced by more than 90%. A total of 5580 confocal endomicroscopic images from 134 circumscribed lesions were compared with histologic results. The presence of neoplastic changes could be predicted by endomicroscopy with high accuracy (sensitivity, 94.7%; specificity, 98.3%; accuracy, 97.8%).
Conclusions: Endomicroscopy based on in vivo histology can determine if UC lesions identified by chromoscopy should undergo biopsy examination, thereby increasing the diagnostic yield and reducing the need for biopsy examinations. Thus, chromoscopy-guided endomicroscopy may lead to significant improvements in the clinical management of UC.
Comment in
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Magnification pan-chromoendoscopy remains the mainstay for colitis dysplasia detection and differentiation.Gastroenterology. 2007 Jul;133(1):366-7; author reply 367. doi: 10.1053/j.gastro.2007.05.042. Gastroenterology. 2007. PMID: 17631163 No abstract available.
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How useful is combined chromoendoscopy and endomicroscopy in patients with ulcerative colitis?Nat Clin Pract Gastroenterol Hepatol. 2008 Mar;5(3):128-9. doi: 10.1038/ncpgasthep1026. Epub 2007 Dec 11. Nat Clin Pract Gastroenterol Hepatol. 2008. PMID: 18073719 No abstract available.