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P334 Chromoendoscopy is superior to white light endoscopy for the detection of advanced colonic neoplasia in patients with inflammatory bowel disease

K. O. Kim*1,2, M. Chiorean2

1Yeungnam University College of Medicine, Division of Gastroenterology and Hepatology, Department of Internal Medicine, Daegu, South Korea, 2Virginia Mason Medical Center, Digestive Disease Institute, Seattle, USA

Background

Although recent guidelines recommend chromoendoscopy (CE) as a method of choice for neoplasia surveillance in inflammatory bowel disease (IBD), there is still controversy regarding the utility of this technique in clinical practice. The aims of this study were to compare the accuracy of CE and white light endoscopy (WLE) for the detection of overall neoplasia and advanced neoplasia in patients with IBD.

Methods

Patients who underwent surveillance colonoscopy were identified from a single institution IBD database from 1999 to 2017. Patients with prior history of colon cancer or total colectomy were excluded. CE procedures were compared with their respective WLE controls in a paired comparison and the frequency of all neoplasia, advanced neoplasia and serrated neoplasia was assessed for both targeted and random biopsies. Demographic and clinical data were obtained from review of medical records

Results

Total 315 procedure performed in 106 individuals were identified over a median follow-up 3 years (median 3 colonoscopy/ patients). Among them, 290 procedures performed in 98 individuals were finally included in the analysis. The median age was 56 years (20–87), 55.1% were male, 69.4% had UC and 11.2% had PSC. CE and WLE were performed in 159 and 131 episodes, respectively. CE detected neoplasia in 40.9% of colonoscopies vs. 23.7% with WLE (p = 0.02). In addition, CE detected more advanced neoplasia (18.2% vs. 6.1%, p = 0.002) and more serrated lesions (14.5% vs. 6.1%, p = 0.02). Significantly fewer samples were obtained per procedure with CE (14.9 ± 9.7 vs. 20.9 ± 11.1, p < 0.01). Cancer was diagnosed in 2 cases, one detected by CE and the other one after colectomy.

Chromoendoscopy (n = 159)White light endoscopy (n = 131)p
Neoplasia per procedure65 (40.9%)31 (23.6%)0.020
Advanced neoplasia per procedure29 (18.2%)8 (6.1%)0.002
Serrated neoplasia per procedure23 (14.5%)8 (6.1%)0.022
Targeted biopsy (mean ±SD)213 (1.3 ± 1.2)89 (0.7 ± 1.0)<0.001
Neoplasia per targeted biopsy88380.819
Random biopsy (mean ± SD)2143 (13.7 ± 9.3)2630 (20.2 ± 10.6)<0.001
Neoplasia per random biopsy450.490

Characteristics of neoplastic lesions detected by chromoendoscopy and white light endoscopy

Conclusion

CE has a higher detection rate than WLE for conventional neoplasia, advanced neoplasia and serrated neoplasia in patients with IBD under surveillance. Considering that significantly fewer biopsies are required, CE may be both more accurate and more cost-effective compared with WLE.