Issue 23

Clinical Question

For colorectal cancer (CRC) surveillance in patients with IBD, how accurate is chromoendoscopy compared to traditional white light colonoscopy?

Editor’s Bottom Line

The large real-life Dutch study by Mooiweer et al has significant flaws and should not yet change practice away from chromoendoscopy for surveillance in IBD patients with colonic disease.

Reference

Current Study: Mooiweer E, van der Meulen-de Jong AE, Ponsioen CY, et al. Chromoendoscopy for surveillance in inflammatory bowel disease does not increase neoplasia detection compared with conventional colonoscopy with random biopsies: results from a large retrospective study. Am J Gastroenterol. 2015 Jul;110(7):1014–21. https://www.ncbi.nlm.nih.gov/pubmed/25823770

Counterpoint: Subramanian V, Mannath J, Ragunath K, et al. Meta-analysis: the diagnostic yield of chromoendoscopy for detecting dysplasia in patients with colonic inflammatory bowel disease. Aliment Pharmacol Ther. 2011;33(3):304–2. https://www.ncbi.nlm.nih.gov/pubmed/21128987

Synopsis – Current Study

In this retrospective non-randomized study, patients with IBD were included providing they had undergone either a white light colonoscopy with random 4 quadrant biopsies every 10 cm, or high definition chromoendoscopy (0.1% methylene blue or 0.3% indigo carmine) and targeted biopsies.

2,242 surveillance colonoscopies performed between 2000 and 2013 for 937 patients (35% Crohn’s disease). White light colonoscopy was performed 1,802 times for 772 patients with dysplasia in 10% of the procedures. In contrast, a total of 440 chromoendoscopy procedures were completed for 401 patients of which 11% detected dysplasia (P=0.80). Furthermore, targeted biopsies with chromoendoscopy did not yield more dysplasia.

Despite its large size significant flaws should be raised with this study:

–  Retrospective non-randomized

–  The adenomatous detection rates were different between endoscopists

–  The two patient groups were not similar; the chromoendoscopy group had more extensive colitis and more family history positive for CRC.

Synopsis – Counterpoint Study

In this meta-analysis of 6 studies (n=1,277), chromoendoscopy identified 7% more patients with dysplasia than white light colonoscopy (95% CI: 3.2–11.3). Furthermore, targeted biopsies with chromoendoscopy yielded 44% more (95% CI: 28.6–59.1) dysplasia.

Details – Current Study

Study Design: Retrospective diagnosis study
Funding: Unrestricted funding from MSD BV and Ferring BV
Allocation: N/A
Setting: 3 centres in The Netherlands
Level of Evidence: 2b (Oxford Levels of Evidence)

Details – Counterpoint Study

Study Design: Meta-analysis
Funding: No funding support
Allocation: N/A
Setting: N/A
Level of Evidence: 1a (Oxford Levels of Evidence)

The summary and conclusion in this issue of E-mentoring in IBD pertains to the manuscript(s) being reviewed, and should be considered in the context of what is already known surrounding the topic and incorporated into practice as deemed appropriate by the individual learner.