Authors (including presenting author) :
Lui RN (1)(2), Kwok HYH (1)(2), Chan A (2), Lau LHS (1)(2), Mak JWY (1)(2), Ng SC (1)(2)
Affiliation :
(1) Division of Gastroenterology and Hepatology, Department of Medicine and Therapeutics, Prince of Wales Hospital, (2) Institute of Digestive Disease, Faculty of Medicine, The Chinese University of Hong Kong
Introduction :
Recent epidemiological studies have shown a striking increase in the incidence rates of inflammatory bowel disease (IBD) in China and the Asia-Pacific region. These patients are at an increased risk of colorectal cancer (CRC) due to the presence of longstanding chronic inflammation. Chromoendoscopy (CE) has emerged as a promising endoscopic technique, combining the use of dye spray +/- image enhancement +/- magnification, to enhance detection rates of adenomas and IBD-associated dysplasia. However, real world experience of this technique in our locality has not been widely reported.
Objectives :
We set out to compare the use of CE versus conventional high definition white light endoscopy (WLE) for the detection of dysplasia in patients with IBD retrospectively from existing databases of ongoing studies.
Methodology :
Subjects recruited to the ACCESS (Asia–Pacific Crohn's and Colitis Epidemiologic Study; NTEC CRE 2010.508) and ASSURANCE (Surveillance for Neoplasia in Inflammatory Bowel Disease; NTEC CRE 2015.051) studies were screened. A total of 368 subjects were reviewed for eligibility, where we included patients with a confirmed diagnosis of IBD (either Crohn’s or ulcerative colitis [UC]), currently followed up in the Gastroenterology Clinic of the Prince of Wales Hospital, had a recent complete colonoscopy performed from 2015 – present, visible lesions detected on endoscopy, and with retrievable and complete data sets.
Result & Outcome :
A total of 99 subjects were recruited (CE – 51; WLE – 48). There were more elderly and male subjects, smokers and patients with ulcerative colitis in the CE group. Low grade dysplasia was detected in 31.4% (16/51) and 18.8% (9/48) of subjects in the CE and WLE groups, respectively. In addition, one indefinite dysplasia, one high-grade dysplasia, and one frank carcinoma were detected in the CE group. A statistically significant improvement in the detection of any neoplastic/dysplastic lesions was noted in the CE group when compared with the WLE group (37.3% vs 18.8%, p-value by χ² = 0.04). Chromoendoscopy almost doubles the detection rate of dysplastic lesions in patients with IBD when compared with conventional high definition white light endoscopy. Proper patient selection, training and education, with sufficient allocation of resources is needed to allow the adoption of CE as the standard of care in the public healthcare sector in line with international guidelines. Adopting CE is paramount to improve the quality of endoscopy to prevent and allow for earlier detection of IBD-associated CRC.
