Copyright
©The Author(s) 2018. Published by Baishideng Publishing Group Inc. All rights reserved.
Real-life chromoendoscopy for dysplasia surveillance in ulcerative colitis
Pasquale Klepp, Anita Tollisen, Arne Røseth, Milada Cvancarova Småstuen, Solveig N Andersen, Morten Vatn, Bjørn A Moum, Stephan Brackmann
Pasquale Klepp, Anita Tollisen, Arne Røseth, Unger-Vetlesen Institute, Department of Internal Medicine, Lovisenberg Diaconal Hospital, Oslo 0456, Norway
Pasquale Klepp, Milada Cvancarova Småstuen, Morten Vatn, Bjørn A Moum, Stephan Brackmann, Institute of Clinical Medicine, University of Oslo, Oslo 0317, Norway
Solveig N Andersen, Department of Pathology, Akershus University Hospital, Lørenskog 1474, Norway
Bjørn A Moum, Department of Gastroenterology, Oslo University Hospital, Oslo 0450, Norway
Stephan Brackmann, Department of Gastroenterology, Akershus University Hospital, Lørenskog 1474, Norway
Author contributions: Klepp P contributed to acquisition, analysis and interpretation of the data, and drafting and revision of the manuscript; Tollisen A contributed to planning and collection of the data; Røseth A contributed to conception and design of the study, and performed critical revision of the manuscript for important intellectual content; Cvancarova Småstuen M contributed to the statistical analysis and critical revision of the manuscript for important intellectual content; Andersen SN provided technical support and contributed to revision of the histopathological material; Vatn M provided critical revision of the manuscript for important intellectual content and performed study supervision; Moum BA and Brackmann S contributed to conception and design of the study, and performed critical revision of the manuscript for important intellectual content and study supervision; all authors have approved the final draft.
Supported by the Unger-Vetlesen Institute, Department of Internal Medicine, Lovisenberg Hospital.
Institutional review board statement: The study protocol was designed according to the combined knowledge and expertise of Assistant Professor Stephan Brackmann (Akershus University Hospital), Professor Bjørn A Moum (Oslo University Hospital) and Professor Morten Vatn (University of Oslo). The study protocol was approved by the Regional Committee for Medical and Health Research Ethics (REC Project NO. 2010/1093).
Informed consent statement: Written informed consent was collected from subjects prior to study inclusion.
Conflict-of-interest statement: The authors have no conflicts of interest.
Data sharing statement: No additional data are available.
STROBE statement: The authors have read the STROBE Statement, and the manuscript was prepared and revised according to the STROBE Statement.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Pasquale Klepp, MD, Attending Doctor, Department of Internal Medicine, Lovisenberg Hospital, Lovisenberggt.17, Oslo 0456, Norway. pasklepp@gmail.com
Telephone: +47-23225000
Received: May 30, 2018
Peer-review started: May 30, 2018
First decision: July 4, 2018
Revised: August 6, 2018
Accepted: August 24, 2018
Article in press: August 24, 2018
Published online: September 21, 2018
AIM
To evaluate the use of chromoendoscopy for surveillance of ulcerative colitis in a real-life community hospital setting.
METHODS
Patients with extensive ulcerative colitis, having disease duration of more than 8 years and who presented between the years of 1999 to 2013, were offered enrolment in this single cohort prospective study. All participants underwent standard bowel preparation with sodium phosphate and chromoendoscopy. Two expert endoscopists, novice to chromoendoscopy, evaluated each segment of the colon with standard-definition colonoscopes after spray application of 0.4% indigo carmine. All observed lesions were recorded and evaluated before being removed and/or biopsied. In addition, nontargeted biopsies were taken from each segment of the colon. The dysplasia detection rate and dysplasia detection yield were ascertained.
RESULTS
A total of 21 neoplastic lesions (2 carcinomas, 4 of high-grade dysplasia and 15 of low-grade dysplasia) and 27 nondysplastic lesions were detected in 16 of the total 67 patients (70% male; median disease duration: 17 years; median age at diagnosis: 25 years; 92% aminosalicylate-treated). The dysplasia detection rate was 10.5% (7/67 patients). The dysplasia detection yield was 20.8% (10/48) for targeted biopsies and 3.5% (11/318) for nontargeted biopsies. The sensitivity and specificity for the macroscopic evaluation of neoplasia using chromoendoscopy were 48% [95% confidence interval (CI): 26%-70%] and 96% (95%CI: 93%-98%), respectively. The positive predictive and negative predictive values were 42% (95%CI: 27%-59%) and 97% (95%CI: 95%-98%), respectively. A total of 19/21 dysplastic lesions were detected in mucosa with histologic inflammation.
CONCLUSION
Chromoendoscopy seems to be of value for dysplasia surveillance of ulcerative colitis in a community hospital setting. The yield of non-targeted biopsies is negligible.
Core tip: Patients with longstanding and extensive ulcerative colitis are at increased risk of developing colonic neoplasia and are advised to undergo regular colonoscopic surveillance. Current clinical guidelines favour chromoendoscopy with targeted biopsies, as it detects dysplasia more accurately and thus requires fewer biopsies than white-light endoscopy. However, these recommendations are based on studies performed in advanced endoscopic units and chromoendoscopy is not routinely applied in everyday clinical practice. This prospective cohort study suggests that, although novice to chromoendoscopy, endoscopists can accurately evaluate the absence of neoplasia. The yield of nontargeted biopsies was also found to be negligible.
