Full-Spectrum Endoscopy Improves Surveillance for Dysplasia in Patients With Inflammatory Bowel Diseases

Rupert W Leong; Marie Ooi; Crispin Corte; Yunki Yau; Melissa Kermeen; Peter H Katelaris; Charles McDonald; Meng Ngu

doi:10.1053/j.gastro.2017.01.008

Full-Spectrum Endoscopy Improves Surveillance for Dysplasia in Patients With Inflammatory Bowel Diseases

Gastroenterology. 2017 May;152(6):1337-1344.e3. doi: 10.1053/j.gastro.2017.01.008. Epub 2017 Jan 23.

Authors

Rupert W Leong¹, Marie Ooi², Crispin Corte³, Yunki Yau⁴, Melissa Kermeen⁵, Peter H Katelaris⁵, Charles McDonald², Meng Ngu⁵

Affiliations

¹ Gastroenterology and Liver Services, Sydney Local Health District, Concord Hospital, Sydney, Australia; Faculty of Medicine, The University of New South Wales, Sydney, Australia; Sydney Medical School, University of Sydney, Sydney, Australia. Electronic address: rupertleong@outlook.com.
² Gastroenterology and Liver Services, Sydney Local Health District, Concord Hospital, Sydney, Australia.
³ Gastroenterology and Liver Services, Sydney Local Health District, Concord Hospital, Sydney, Australia; Faculty of Medicine, The University of New South Wales, Sydney, Australia; Sydney Medical School, University of Sydney, Sydney, Australia.
⁴ Gastroenterology and Liver Services, Sydney Local Health District, Concord Hospital, Sydney, Australia; Faculty of Medicine, The University of New South Wales, Sydney, Australia.
⁵ Gastroenterology and Liver Services, Sydney Local Health District, Concord Hospital, Sydney, Australia; Sydney Medical School, University of Sydney, Sydney, Australia.

PMID: 28126349
DOI: 10.1053/j.gastro.2017.01.008

Abstract

Background & aims: Inflammatory bowel diseases (IBDs) increase the risk of colorectal cancer. Surveillance colonoscopy with chromoendoscopy is recommended, but conventional forward-viewing colonoscopy (FVC) detects dysplasia with low levels of sensitivity. Full-spectrum endoscopy (FUSE) incorporates 2 additional lateral cameras to the forward camera of the colonoscope, allowing endoscopists to view behind folds and in blind spots, which might increase dysplasia detection. We compared FUSE vs FVC in the detection of dysplasia in patients with IBDs.

Methods: We performed a prospective, randomized, cross-over, tandem colonoscopy study comparing FVC vs FUSE in 52 subjects with IBD undergoing surveillance for neoplasia in Australia (23 with Crohn's colitis, 29 with ulcerative colitis; median age, 45.0 y; 60% male; mean IBD duration, 16.4 y). All subjects met national IBD surveillance inclusion criteria; 27 were assigned randomly to groups that underwent FVC followed by FUSE, and 25 were assigned to groups that underwent FUSE followed by FVC. All procedures were performed from February 2014 through December 2015. Random biopsy specimens were collected and visible lesions were collected; all were analyzed histologically. The primary end point was dysplasia missed by the first colonoscopy detected by the second colonoscopy. Dysplasia was diagnosed by an expert gastrointestinal pathologist blinded to the colonoscope allocation in consensus with a second expert pathologist.

Results: FVC missed 71.4% of dysplastic lesions per lesion whereas FUSE missed 25.0% per lesion (P = .0001); FVC missed 75.0% of dysplastic lesions per subject and FUSE missed 25.0% per subject (P = .046). FUSE identified a mean of 0.37 dysplastic lesions and FVC identified a mean of 0.13 dysplastic lesions (P = .044). The total colonoscopy times were similar (21.2 min for FUSE vs 19.1 min for FVC; P = .32), but withdrawal time was significantly longer for FUSE (15.8 min) than for FVC (12.0 min) (P = .03). Correcting for per-unit withdrawal time, the mean dysplasia miss rate per subject was significantly lower for FUSE (0.19) than for FVC (0.83; P < .0001). Targeted tissue acquisition identified significantly more dysplastic lesions than random biopsies (P < .0001).

Conclusions: In a prospective cross-over study of IBD patients undergoing surveillance colonoscopy, we found panoramic views obtained by full-spectrum endoscopy increased the number of dysplastic lesions detected, compared with conventional forward-viewing colonoscopy. Trial no: ACTRN12616000047493.

Keywords: Colon Cancer; Crohn’s Disease; FUSION Study; Neoplasm.

Publication types

Comparative Study
Randomized Controlled Trial
Research Support, Non-U.S. Gov't

MeSH terms

Adult
Biopsy
Colitis, Ulcerative / complications
Colitis, Ulcerative / diagnostic imaging*
Colitis, Ulcerative / pathology*
Colon / pathology
Colonoscopy / instrumentation
Colonoscopy / methods*
Colorectal Neoplasms / diagnostic imaging*
Colorectal Neoplasms / etiology
Crohn Disease / complications
Crohn Disease / diagnostic imaging*
Crohn Disease / pathology*
Cross-Over Studies
False Negative Reactions
Female
Humans
Male
Middle Aged
Operative Time
Population Surveillance / methods*
Prospective Studies
Single-Blind Method