Chromoendoscopy with targeted biopsies is superior to white-light endoscopy for the long-term follow-up detection of dysplasia in ulcerative colitis patients: a multicenter randomized-controlled trial

Jian Wan; Qin Zhang; Shu-Hui Liang; Jie Zhong; Jing-Nan Li; Zhi-Hua Ran; Fa-Chao Zhi; Xiao-Di Wang; Xiao-Lan Zhang; Zhong-Hui Wen; Jian-Qiu Sheng; Hua-Xiu Shi; Qiao Mei; Kai-Chun Wu

doi:10.1093/gastro/goaa028

Chromoendoscopy with targeted biopsies is superior to white-light endoscopy for the long-term follow-up detection of dysplasia in ulcerative colitis patients: a multicenter randomized-controlled trial

Gastroenterol Rep (Oxf). 2020 Sep 20;9(1):14-21. doi: 10.1093/gastro/goaa028. eCollection 2021 Jan.

Authors

Jian Wan¹, Qin Zhang¹, Shu-Hui Liang¹, Jie Zhong², Jing-Nan Li³, Zhi-Hua Ran⁴, Fa-Chao Zhi⁵, Xiao-Di Wang⁶, Xiao-Lan Zhang⁷, Zhong-Hui Wen⁸, Jian-Qiu Sheng⁹, Hua-Xiu Shi¹⁰, Qiao Mei¹¹, Kai-Chun Wu¹

Affiliations

¹ State Key Laboratory of Cancer Biology, National Clinical Research Center for Digestive Diseases and Xijing Hospital of Digestive Diseases, Fourth Military Medical University, Xi'an, Shaanxi, P. R. China.
² Department of Gastroenterology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, P. R. China.
³ Department of Gastroenterology, Peking Union Medical College Hospital, Beijing, P. R. China.
⁴ Division of Gastroenterology and Hepatology, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, P. R. China.
⁵ Department of Gastroenterology, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, P. R. China.
⁶ Department of Gastroenterology, China-Japan Friendship Hospital, Beijing, P. R. China.
⁷ Department of Gastroenterology, the Second Hospital of Hebei Medical University, Shijiazhuang, Hebei, P. R. China.
⁸ Department of Gastroenterology, West China Hospital, Sichuan University, Chengdu, Sichuan, P. R. China.
⁹ Department of Gastroenterology, PLA Army General Hospital, Beijing, P. R. China.
¹⁰ Department of Gastroenterology, Zhongshan Hospital Affiliated to Xiamen University, Xiamen University Institute of Digestive Disease, Xiamen, Fujian, P. R. China.
¹¹ Department of Gastroenterology, the First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, P. R. China.

Abstract

Background: Data from single-center experience or small sample-sized studies have shown that chromoendoscopy (CE) might be superior to white-light endoscopy (WLE) for dysplasia surveillance in ulcerative colitis (UC) patients. We performed a prospective randomized trial with a long-term follow-up to compare the detection rate of dysplasia among WLE with targeted biopsies (WLT), WLE with random biopsies (WLR), and dye-based CE with targeted biopsies (CET) in UC patients.

Methods: Patients with long-standing UC were enrolled from 11 medical centers from March 2012 to December 2013 and randomized into three arms (WLT, WLR, and CET). Only high-definition endoscopy was used in all three groups. The patients were followed up by annual endoscopy with biopsies through December 2017.

Results: With a median follow-up time of 55 months, a total of 122 patients with 447 colonoscopies were finally analysed in the per-protocol set: WLT (n = 43), WLR (n = 40), and CET (n = 39). A total of 34 dysplastic lesions were found in 29 colonoscopies of 21 patients. WLR and CET could identify more colonoscopies that diagnosed dysplasia than WLT (8.1% and 9.7% vs 1.9%; P = 0.014 and 0.004, respectively). WLR obtained more biopsied samples than WLT and CET (16.4 ± 5.1 vs 4.3 ± 1.4 and 4.3 ± 1.4; both P < 0.001). During the second half of the follow-up (37 - 69 months), CET could identify more colonoscopies that diagnosed dysplasia than WLT (13.3% vs 1.6%, P = 0.015) and showed a trend for increasing the detection rate compared with WLR (13.3% vs 4.9%, P = 0.107).

Conclusions: For a better outcome of cancer/dysplasia surveillance in patients with long-standing UC, CET appeared to be more effective than WLT and less tedious than WLR. CET was found to be particularly useful when a long-term (>3 years) follow-up was conducted for dysplasia surveillance. The trial was registered on www.chictr.org.cn (ChiCTR1900023689).

Keywords: chromoendoscopy; dysplasia; ulcerative colitis; white-light endoscopy.