Endocuff Vision is safe to use for dysplasia surveillance in patients with ulcerative colitis: a feasibility study

Abstract

Background and study aims Endocuff Vision improves adenoma detection rates in patients without inflammatory bowel disease. This study aimed to investigate the safety and feasibility of Endocuff Vision-assisted high-definition white light endoscopy (HDWLE) with dye-spray chromoendoscopy for detection of dysplasia in patients with ulcerative colitis.

Patients and methods Patients with clinically inactive ulcerative colitis due for dysplasia surveillance were recruited. Procedural endpoints included safety, cecal intubation rate (CIR), terminal ileum intubation rate (TIR), withdrawal time, polyp detection rate, dysplasia detection rate (DDR), and sessile serrated lesion detection rate.

Results Twenty-five patients (9 female, median age 57 [range 28 – 82] years) were studied. Endocuff Vision-assisted HDWLE was completed in all participants, with a CIR of 100 %, in a median 4 minutes (range 2 – 16), and a TIR of 88% in a median of 6.5 minutes (range 3 – 19). Median withdrawal time was 18 minutes (range 10 – 55), including application of dye-spray, biopsies and polypectomy. The Mayo Endoscopic subscore was 0 in 11, 1 in 9, and 2 in 5 patients. The DDR was 24 % (6 patients had a total of 12 dysplastic lesions) and sessile serrated lesion detection rate was 12 % (3 patients had a total of 4 sessile serrated polyps). No serious adverse events occurred, with one patient developing clinically insignificant minor mucosal bleeding.

Conclusion Endocuff Vision-assisted HDWLE is feasible and safe in patients with ulcerative colitis undergoing dysplasia surveillance. Further studies are required to assess superiority of this technique compared with standard high-definition white light endoscopy with chromoendoscopy.

• References

• 1 Laine L, Kaltenbach T, Barkun A. et al. SCENIC international consensus statement on surveillance and management of dysplasia in inflammatory bowel disease. Gastroenterology 2015; 148: 639-651
• 2 Farraye FA, Odze RD, Eaden J. et al. AGA medical position statement on the diagnosis and management of colorectal neoplasia in inflammatory bowel disease. Gastroenterology 2010; 138: 738-745
• 3 Rutter MD, Saunders BP, Wilkinson KH. et al. Most dysplasia in ulcerative colitis is visible at colonoscopy. Gastrointest Endosc 2004; 60: 334-339
• 4 Rubin DT, Rothe JA, Hetzel JT. et al. Are dysplasia and colorectal cancer endoscopically visible in patients with ulcerative colitis?. Gastrointest Endosc 2007; 65: 998-1004
• 5 Annese V, Daperno M, Rutter MD. et al. European evidence based consensus for endoscopy in inflammatory bowel disease. J Crohns Colitis 2013; 7: 982-1018
• 6 Lutgens M, Oldenburg B, Siersema P. et al. Colonoscopic surveillance improves survival after colorectal cancer diagnosis in inflammatory bowel disease. Br J Cancer 2009; 101: 1671-1675
• 7 Rutter M, Bernstein C, Matsumoto T. et al. Endoscopic appearance of dysplasia in ulcerative colitis and the role of staining. Endoscopy 2004; 36: 1109-1114
• 8 Neumann H, Vieth M, Langner C. et al. Cancer risk in IBD: how to diagnose and how to manage DALM and ALM. World J Gastroenterol 2011; 17: 3184
• 9 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: 304-312
• 10 Subramanian V, Ramappa V, Telakis E. et al. Comparison of high definition with standard white light endoscopy for detection of dysplastic lesions during surveillance colonoscopy in patients with colonic inflammatory bowel disease. Inflamm Bowel Dis 2012; 19: 350-355
• 11 Rutter M, Saunders B, Schofield G. et al. Pancolonic indigo carmine dye spraying for the detection of dysplasia in ulcerative colitis. Gut 2004; 53: 256-260
• 12 Choi C-HR, Rutter MD, Askari A. et al. Forty-year analysis of colonoscopic surveillance program for neoplasia in ulcerative colitis: an updated overview. Am J Gastroenterol 2015; 110: 1022
• 13 Patil R, Ona MA, Ofori E. et al. Endocuff-assisted colonoscopy – a novel accessory in improving adenoma detection rate: a review of the literature. Clin Endosc 2016; 49: 533
• 14 Floer M, Biecker E, Fitzlaff R. et al. Higher adenoma detection rates with endocuff-assisted colonoscopy – a randomized controlled multicenter trial. PLoS One 2014; 9: e114267
• 15 Marsano J, Tzimas D, Mckinley M. et al. Tu1465 Endocuff assisted colonoscopy increases adenoma detection rates: a multi-center study. Gastrointest Endosc 2014; 79: AB550
• 16 Biecker E, Floer M, Heinecke A. et al. Novel endocuff-assisted colonoscopy significantly increases the polyp detection rate: a randomized controlled trial. J Clin Gastroenterol 2015; 49: 413-418
• 17 González-Fernández C, García-Rangel D, Aguilar-Olivos NE. et al. Higher adenoma detection rate with the endocuff: a randomized trial. Endoscopy 2017; 49: 1061-1068
• 18 Triantafyllou K, Polymeros D, Apostolopoulos P. et al. Endocuff-assisted colonoscopy is associated with a lower adenoma miss rate: a multicenter randomized tandem study. Endoscopy 2017; 49: 1051-1060
• 19 Medical A. Endocuff Vision Instructions for Use. In: Medical A, editor. 6th. ed: Arc Medical;
• 20 Walmsley R, Ayres R, Pounder R. et al. A simple clinical colitis activity index. Gut 1998; 43: 29-32
• 21 Shergill AK, Lightdale JR, Bruining DH. et al. The role of endoscopy in inflammatory bowel disease. Gastrointest Endosc 2015; 81: 1101-1121 e1113
• 22 Cancer Council Australia Colonoscopy Surveilance Working Party. Clinical Practice Guidelines for Surveillance Colonoscopy-in adenoma follow-up; following curative resection of colorectal cancer; and for cancer surveillance in inflammatory bowel disease. Cancer Council Australia; 2011
• 23 Lai EJ, Calderwood AH, Doros G. et al. The Boston bowel preparation scale: a valid and reliable instrument for colonoscopy-oriented research. Gastrointest Endosc 2009; 69: 620-625
• 24 Dyson JK, Rutter MD. Colorectal cancer in inflammatory bowel disease: what is the real magnitude of the risk. World J Gastroenterol 2012; 18: 3839-3848
• 25 Pohl J, Schneider A, Vogell H. et al. Pancolonic chromoendoscopy with indigo carmine versus standard colonoscopy for detection of neoplastic lesions: a randomised two-centre trial. Gut 2011; 60: 485-490
• 26 Sawatzki M, Meyenberger C, Marbet UA. et al. Prospective Swiss pilot study of Endocuff-assisted colonoscopy in a screening population. Endosc Int Open 2015; 3: E236
• 27 Lenze F, Beyna T, Lenz P. et al. Endocuff-assisted colonoscopy: a new accessory to improve adenoma detection rate? Technical aspects and first clinical experiences. Endoscopy 2014; 46: 610-614
• 28 Van Doorn S, Van der Vlugt M, Depla A. et al. Adenoma detection with Endocuff colonoscopy versus conventional colonoscopy: a multicentre randomised controlled trial. Gut 2017; 66: 438-445
• 29 Kiesslich R, Fritsch J, Holtmann M. et al. Methylene blue-aided chromoendoscopy for the detection of intraepithelial neoplasia and colon cancer in ulcerative colitis. Gastroenterology 2003; 124: 880-888
• 30 Bisschops R, Bessissow T, Joseph JA. et al. Chromoendoscopy versus narrow band imaging in UC: a prospective randomised controlled trial. Gut 2018; 67: 1087-1094
• 31 Vieth M, Neumann H. Current issues in inflammatory bowel disease neoplasia. Histopathology 2015; 66: 37-48
• 32 Van Schaik FD, Offerhaus GJA, Schipper ME. et al. Endoscopic and pathological aspects of colitis-associated dysplasia. Nat Rev Gastroenterol Hepatol 2009; 6: 671
• 33 Leong RW, Ooi M, Corte C. et al. Full-spectrum endoscopy improves surveillance for dysplasia in patients with inflammatory bowel diseases. Gastroenterology 2017; 152: 1337-1344 e1333