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DOP065 Use of chromoendoscopy versus white light endoscopy for colorectal cancer surveillance in inflammatory bowel disease patients with primary sclerosing cholangitis; a six year experience

Hartery K., Williamson K., Chapman R., Atkinson N., East J.

John Radcliffe Hospital, Translation Gastroenterology Unit, Oxford, United Kingdom

Background

Patients with inflammatory bowel disease (IBD) are at increased risk for development of dysplasia and colorectal cancer (CRC), with a further 6-fold increased risk in those with primary sclerosing cholangitis (PSC) versus their non-PSC-IBD counterparts. Preneoplastic tissue in IBD patients is often flat and multifocal and may not be appreciated in up to one-third of colonoscopies. The dysplasia yield from surveillance colonoscopy can be improved by spraying dyes that highlight subtle changes in the architecture of the colonic mucosa. Limited data exists on outcomes of chromoendoscopy in PSC-IBD population. Our aim was to audit the endoscopic outcomes of CRC surveillance in PSC-IBD patients, comparing chromoendoscopy (CE) versus white-light endoscopy (WLE), over a six-year period.

Methods

Retrospective study analyzing our Oxford PSC database to identify patients actively followed up since January 1st, 2010. Patients were excluded who did not have a diagnosis of IBD, had a colectomy prior to January 1st, 2010, or did not under go endoscopic surveillance at our institution. Endoscopic and histological findings were recorded from endoscopic electronic reporting systems (EndoBase and UNISOFT), and histology reports from NHS Casenotes. Procedures were excluded if bowel preparation was inadequate or evidence of moderate inflammation.

Results

140 PSC patients were followed up during study period, of which 58 PSC-IBD patients attended our institution for their endoscopic surveillance (38 UC, 10 Crohn's disease, and 10 IBD-U). The median disease duration at time of colonoscopy was 12.4 years (7.3–24.5). 178 colonoscopies were performed on this population, of which 57 were excluded due to poor prep and active inflammation. 122 procedures were analysed. 74 were performed with CE while 48 with WLE. High definition scope was more likely to be used at CE than WLE procedures (58.3% versus 28.2%, p=0.005). Targeted biopsies were taken at time of 23/74 (31.1%) CE procedures (one high grade dysplasia (HGD), two low grade dysplasia (LGD), one indefinite for dysplasia (IFD), one sessile serrated polyp (SSP), and three hyperplastic changes (all right colon)) versus 1/48 (2.2%) WLE procedures (normal) (p<0.001). More visible lesions were identified at chromoendoscopy (p=0.04), with 78 identified in CE procedures (one HGD, two LGD, one IFD, three SSP, 24 hyperplastic polyps (15 right sided), and 5 adenomatous polyps) versus 18 in WLE procedures (no dysplastic lesions, five hyperplastic (two right sided)). Premalignant lesions were more likely to be detected at CE (p=0.006).

Conclusion

This study shows evolving clinical practice at a single centre with increased detection of premalignant lesions with CE versus WLE for PSC-IBD patients.