Endoscopy 2007; 39(3): 216-221
DOI: 10.1055/s-2007-966214
Original article
© Georg Thieme Verlag KG Stuttgart · New York

Narrow-band imaging compared with conventional colonoscopy for the detection of dysplasia in patients with longstanding ulcerative colitis

E.  Dekker1 , F.  J.  C.  van den Broek1 , J.  B.  Reitsma2 , J.  C.  Hardwick1 , G.  J.  Offerhaus3 , S.  J.  van Deventer1 , D.  W.  Hommes1 , P.  Fockens1
  • 1Department of Gastroenterology and Hepatology, Academic Medical Center, Amsterdam, The Netherlands
  • 2Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Academic Medical Center, Amsterdam, The Netherlands
  • 3Department of Pathology, UMC Utrecht, The Netherlands
Weitere Informationen

Publikationsverlauf

submitted 26 October 2006

accepted after revision 16 January 2007

Publikationsdatum:
26. März 2007 (online)

Background and study aim: Patients with longstanding ulcerative colitis are at increased risk of developing colorectal cancer. Colonoscopic surveillance is advised, but the detection of neoplasia by conventional colonoscopy is difficult. The aim of this study was to compare the accuracy of narrow-band imaging (NBI), a new imaging technique, with standard colonoscopy for the detection of neoplasia in patients with longstanding ulcerative colitis.

Patients and methods: This was a prospective, randomized, crossover study of 42 patients with longstanding ulcerative colitis. All participants underwent NBI and conventional colonoscopy with at least 3 weeks between the procedures. Randomization determined the order of the examinations. Targeted biopsies were taken during both procedures; additional random biopsies were taken at conventional colonoscopy only. The number of patients with neoplasia detected by targeted biopsies was used to assess the sensitivity for each technique.

Results: With NBI, 52 suspicious lesions were detected in 17 patients, compared with 28 suspicious lesions in 13 patients detected during conventional colonoscopy. Histopathological evaluation of targeted biopsies revealed 11 patients with neoplasia: in four patients the neoplasia was detected by both techniques, in four patients neoplasia was detected only by NBI, and in three patients neoplasia was detected only by conventional colonoscopy (P = 0.705). Aside from targeted biopsies, 1522 random biopsies were taken. These revealed one additional patient with dysplasia that was not detected by either technique.

Conclusions: The sensitivity of the studied first-generation NBI system for the detection of patients with neoplasia seems to be comparable to conventional colonoscopy, although more suspicious lesions were found during NBI. We believe that it is still too early to stop taking additional random biopsies at surveillance colonoscopy in patients with ulcerative colitis.

References

  • 1 Itzkowitz S H, Harpaz N. Diagnosis and management of dysplasia in patients with inflammatory bowel diseases.  Gastroenterology. 2004;  126 1634-1648
  • 2 Eaden J A, Abrams K R, Mayberry J F. The risk of colorectal cancer in ulcerative colitis: a meta-analysis.  Gut. 2001;  48 526-535
  • 3 Rutter M D, Saunders B P, Wilkinson K H. et al . Thirty-year analysis of a colonoscopic surveillance program for neoplasia in ulcerative colitis.  Gastroenterology. 2006;  130 1030-1038
  • 4 Itzkowitz S H, Present D H. Consensus conference: colorectal cancer screening and surveillance in inflammatory bowel disease.  Inflamm Bowel Dis. 2005;  11 314-321
  • 5 Eaden J A, Mayberry J F. Guidelines for screening and surveillance of asymptomatic colorectal cancer in patients with inflammatory bowel disease.  Gut. 2002;  51 Suppl 5 V10-V12
  • 6 Winawer S J, Fletcher R H, Miller L. et al . Colorectal cancer screening: clinical guidelines and rationale.  Gastroenterology. 1997;  112 594-642
  • 7 Tytgat G N, Dhir V, Gopinath N. Endoscopic appearance of dysplasia and cancer in inflammatory bowel disease.  Eur J Cancer. 1995;  31A 1174-1177
  • 8 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
  • 9 Dekker E, Fockens P. New endoscopic tools for the IBD physician.  Inflamm Bowel Dis. 2004;  10 Suppl 1 S7-S10
  • 10 Dekker E, Fockens P. Advances in colonic imaging: new endoscopic imaging methods.  Eur J Gastroenterol Hepatol. 2005;  17 803-808
  • 11 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
  • 12 Rutter M D, Saunders B P, Schofield G. et al . Pancolonic indigo carmine dye spraying for the detection of dysplasia in ulcerative colitis.  Gut. 2004;  53 256-260
  • 13 Hurlstone D P, Sanders D S, Lobo A J. et al . Indigo carmine-assisted high-magnification chromoscopic colonoscopy for the detection and characterisation of intraepithelial neoplasia in ulcerative colitis: a prospective evaluation.  Endoscopy. 2005;  37 1186-1192
  • 14 Kuznetsov K, Lambert R, Rey J F. Narrow-band imaging: potential and limitations.  Endoscopy. 2006;  38 76-81
  • 15 Machida H, Sano Y, Hamamoto Y. et al . Narrow-band imaging in the diagnosis of colorectal mucosal lesions: a pilot study.  Endoscopy. 2004;  36 1094-1098
  • 16 East J E, Suzuki N, von Herbay A, Saunders B P. Narrow band imaging with magnification for dysplasia detection and pit pattern assessment in ulcerative colitis surveillance: a case with multiple dysplasia associated lesions or masses.  Gut. 2006;  55 1432-1435
  • 17 Truelove S C, Witts L J. Cortisone in ulcerative colitis: final report on a therapeutic trial.  Br Med J. 1955;  2 1041-1048
  • 18 Gono K, Obi T, Yamaguchi M. et al . Appearance of enhanced tissue features in narrow-band endoscopic imaging.  J Biomed Opt. 2004;  9 568-577
  • 19 Schlemper R J, Riddell R H, Kato Y. et al . The Vienna classification of gastrointestinal epithelial neoplasia.  Gut. 2000;  47 251-255
  • 20 Kudo S, Rubio C A, Teixeira C R. et al . Pit pattern in colorectal neoplasia: endoscopic magnifying view.  Endoscopy. 2001;  33 367-373
  • 21 Ullman T, Croog V, Harpaz N. et al . Progression of flat low-grade dysplasia to advanced neoplasia in patients with ulcerative colitis.  Gastroenterology. 2003;  125 1311-1319

E. Dekker, MD

Department of Gastroenterology and Hepatology

Academic Medical Center

Meibergdreef 9

1105 AZ Amsterdam

The Netherlands

Fax: +31-20-691-7033

eMail: e.dekker@amc.uva.nl