OP023 Comparison between newly developed narrow band imaging and panchromoendoscopy for surveillance colonoscopy in patients with ulcerative colitis: a prospective multicentre randomised controlled trial, navigator study
K. Watanabe*1, M. Nishishita2, F. Shimamoto3, T. Fukuchi4, M. Esaki5, Y. Okamoto5, Y. Maehata5, S. Oka6, S. Nishiyama6, S. Fujii7, F. Hirai8, T. Inoue9, N. Hida10, R. Nozaki11, T. Sakurai12, K. Takeuchi13, M. Saruta14, S. Saito15, Y. Saito16, N. Ohmiya17, H. Kashida12, S. Tanaka6, T. Matsui8, Y. Suzuki18, Y. Ajioka19, H. Tajiri20
1Osaka City General Hospital, Gastroenterology, Osaka, Japan, 2Nishishita Gastrointestinal Hospital, Osaka, Japan, 3Faculty of Human Culture and Science Prefectural University of Hiroshima, Hiroshima, Japan, 4Osakafu Saiseikai Nakatsu Hospital, Gastroenterology and Hepatology, Osaka, Japan, 5Graduate School of Medical Sciences, Kyushu University, Department of Medicine and Clinical Science, Fukuoka, Japan, 6Hiroshima University Hospital, Department of Endoscopy, Hiroshima, Japan, 7Kyoto Katsura Hospital, Digestive Disease Centre, Department of Gastroenterology, Kyoto, Japan, 8Fukuoka University Chikushi Hospital, Department of Gastroenterology, Fukuoka, Japan, 9Osaka Medical College, Second Department of Internal Medicine, Osaka, Japan, 10Hyogo College of Medicine, Department of Inflammatory Bowel Disease, Hyogo, Japan, 11Takano Hospital, Division of Gastroenterology, Coloproctology Centre, Kumamoto, Japan, 12Kinki University, Department of Gastroenterology, Osaka, Japan, 13Toho University Sakura Medical Centre, Department of Internal Medicin, Chiba, Japan, 14The Jikei University School of Medicine, Division of Gastroenterology and Hepatology, Department of Internal Medicine, Tokyo, Japan, 15The Jikei University School of Medicine, Department of Endoscopy, Tokyo, Japan, 16National Cancer Centre Hospital, Endoscopy Division, Tokyo, Japan, 17School of Medicine, Fujita Health University, Department of Gastroenterology, Aichi, Japan, 18Toho University Sakura Medical Centre, Department of Internal Medicine, Chiba, Japan, 19Graduate School of Medical and Dental Sciences, Niigata University, Division of Molecular and Diagnostic Pathology, Niigata, Japan, 20The Jikei University School of Medicine, Division of Gastroenterology and Hepatology, Department of Internal Medicine, Department of Endoscopy, Tokyo, Japan
Trends towards more accurate surveillance colonoscopy (SC) in patients with longstanding ulcerative colitis (UC) favour the use of dye-sprayed chromoendoscopy with a targeted biopsy approach. Previous studies showed no additional efficacy of narrow band imaging (NBI) for the detection of neoplastic lesions as compared with white light endoscopy or chromoendoscopy. The newly developed NBI improved the resolution and brightness of distant views. The aim of the present study was to compare the newly developed pancolonic NBI endoscopy procedure with panchromoendoscopy (PCE) for the detection of neoplastic lesions and in terms of procedure time in patients with UC.
This was a prospective multicentre randomised controlled trial involving 13 institutes in Japan (UMIN000013527). Inclusion criteria were left-sided or pancolitis, a disease duration exceeding 7 years, and a partial Mayo score of up to 2 (0 or 1 endoscopic sub score). The PCE group underwent pancolonic colonoscopy with spraying of indigo carmine solution, and the NBI group with pancolonic NBI observation (Olympus EVIS LUCERA ELITE: CF-HQ290I), mainly with targeted biopsy. Two experienced pathologists using immunohistochemical staining made pathological diagnoses. The primary endpoint was the detection rate of neoplastic lesions in both groups.
In total, 263 patients were randomised to the PCE group (130) and the NBI group (133). Median age was 51.0 years, and median duration of disease was 13.0 years; there were 136 males, 79 refractory cases, 15 with a history of UC associated neoplastic lesion, 7 with a family history of colorectal cancer, and 2 with primary sclerosing cholangitis. As to preliminary results, the partial Mayo score was 0 in 196 patients, 1 in 50, and 2 in 17. Mean insertion time was 4 minutes, and mean observational time was 12 minutes 49 seconds. In total, 309 targeted biopsies and 58 non-targeted biopsies were performed, and the average number of biopsies was 1.49 per patient. Detection rates did not differ significantly between the PCE group (10.7%: 11 sporadic adenoma, 3 low-grade dysplasia, and 2 high-grade dysplasia or cancer) and the NBI group (11.9%: 15 sporadic adenoma, 3 low-grade dysplasia, and 5 high-grade dysplasia or cancer). Mean observational time was significantly shorter in the NBI group (11 minutes) than in the CRE group (15 minutes) (p < 0.001). Main NBI findings of the Japan NBI Expert Team (JNET) for neoplastic lesions were type 2 for non-magnifying colour view, type 2A/2B for vessel patterns, and type 2A/ 2B for surface patterns.
Surveillance colonoscopy using the newly developed pancolonic NBI observation was not inferior to that of panchromoendoscopy and was found to be a timesaving procedure.