Issue 13

Clinical Question

Does a full-spectrum colonoscopy detect more dysplastic lesions in inflammatory bowel disease patients than conventional colonoscopy?

Editor’s Bottom Line

Full spectrum colonoscopy is a promising technology for dysplasia surveillance. Data from larger series at other centres will be needed to know whether it is feasible and effective in wider practice.

Reference

Leong RW, Ooi M, Corte C, et al. Full-Spectrum Endoscopy Improves Surveillance for Dysplasia in Patients with Inflammatory Bowel Diseases. Gastroenterol. 2017 May:152(6):1337–44.e3. https://doi.org/10.1053/j.gastro.2017.01.008

Synopsis

This prospective, randomized, cross-over study conducted in Australia compared conventional high-definition forward-viewing colonoscopy (FVC) to full-spectrum endoscopy (FUSE). FUSE incorporates 2 additional lateral cameras to provide a 330° view of the mucosa, compared to the 170° view seen through FVC. The study included 23 individuals with Crohn’s colitis and 29 with ulcerative colitis who were undergoing surveillance for neoplasia. The median age was 45 years, 60% were male and the mean duration of IBD was 16.4 years. Twenty-seven patients were randomly assigned to undergo FVC first followed by FUSE and 25 underwent FUSE followed by FVC. Regardless of the order of FVC or FUSE, the first colonoscopy was performed with white light both on insertion and withdrawal and the second colonoscopy was performed using segmental dye-spray chromoendoscopy upon withdrawal from the cecum.

Results showed that 30.8% of patients had dysplasia. FVC missed roughly 75% of dysplastic lesions visually identified through FUSE, and FUSE missed 25% of lesions identified by FVC when the latter was performed first (P<0.05). Several additional lesions were found through random biopsy with both instruments. Additionally, both modalities missed dysplastic lesions using white-light alone, with chromoendoscopy identifying seven additional subjects with dysplasia. The total procedure times were similar with the two approaches, but withdrawal time was significantly longer for FUSE (15.8 vs. 12.0 minutes for FUSE and FVC, respectively; P=0.03).

Details

Study Design: Prospective cross-over trial
Funding: Endochoice
Allocation: Randomized
Setting: Multicenter trial
Level of Evidence: 1b (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.