Real-life chromoendoscopy for neoplasia detection and characterisation in long-standing IBD
Por:
Carballal S, Maisterra S, López-Serrano A, Gimeno-García AZ, Vera MI, Marín-Garbriel JC, Díaz-Tasende J, Márquez L, Álvarez MA, Hernández L, De Castro L, Gordillo J, Puig I, Vega P, Bustamante-Balén M, Acevedo J, Peñas B, López-Cerón M, Ricart E, Cuatrecasas M, Jimeno M and Pellisé M
Publicada:
1 ene 2018
Ahead of Print:
9 sep 2016
Categoría:
Gastroenterology
Resumen:
Objective Outside clinical trials, the effectiveness of chromoendoscopy (CE) for long-standing IBD surveillance is controversial. We aimed to assess the effectiveness of CE for neoplasia detection and characterisation, in real-life.
Design From June 2012 to 2014, patients with IBD were prospectively included in a multicentre cohort study. Each colonic segment was evaluated with white light followed by 0.4% indigo carmine CE. Specific lesions' features were recorded. Optical diagnosis was assessed. Dysplasia detection rate between expert and non-expert endoscopists and learning curve were ascertained.
Results Ninety-four (15.7%) dysplastic (1 cancer, 5 high-grade dysplasia, 88 low-grade dysplasia) and 503 (84.3%) non-dysplastic lesions were detected in 350 patients (47% female; mean disease duration: 17 years). Colonoscopies were performed with standard definition (41.5%) or high definition (58.5%). Dysplasia miss rate with white light was 40/94 (57.4% incremental yield for CE). CE-incremental detection yield for dysplasia was comparable between standard definition and high definition (51.5% vs 52.3%, p=0.30). Dysplasia detection rate was comparable between expert and non-expert (18.5% vs 13.1%, p=0.20). No significant learning curve was observed (8.2% vs 14.2%, p=0.46). Sensitivity, specificity, and positive and negative predictive values for dysplasia optical diagnosis were 70%, 90%, 58% and 94%, respectively. Endoscopic characteristics predictive of dysplasia were: proximal location, loss of innominate lines, polypoid morphology and Kudo pit pattern III-V.
Conclusions CE presents a high diagnostic yield for neoplasia detection, irrespectively of the technology and experience available in any centre. In vivo, CE optical diagnosis is highly accurate for ruling out dysplasia, especially in expert hands. Lesion characteristics can aid the endoscopist for in situ therapeutic decisions.
Filiaciones:
Carballal S:
Gastroenterology Department, Hospital Clínic de Barcelona, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Institut d'Investigacions Biomediques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Barcelona, Spain
Maisterra S:
Gastroenterology Department, Hospital Universitario de Bellvitge, Hospitalet de Llobregat, Barcelona, Spain
:
Gastroenterology Department, Hospital Universitari Dr. Peset, Valencia, Spain
Gimeno-García AZ:
Gastroenterology Department, Hospital Universitario de Canarias, La Laguna, Spain
Vera MI:
Gastroenterology Department, Hospital Puerta del Hierro, Madrid, Spain
Marín-Garbriel JC:
Gastroenterology Department, Hospital Universitario 12 de Octubre, Madrid, Spain
Díaz-Tasende J:
Gastroenterology Department, Hospital Universitario 12 de Octubre, Madrid, Spain
Márquez L:
Gastroenterology Department, Hospital del Mar, Barcelona, Spain
Álvarez MA:
Gastroenterology Department, Hospital del Mar, Barcelona, Spain
Hernández L:
Digestive Disease Section, Hospital Universitario de Móstoles, Madrid, Spain
De Castro L:
Gastroenterology Department, Complexo Hospitalario Universitario de Vigo, Instituto de Investigación Biomédica. Estructura Organizativa de Xestión Integrada de Vigo, Vigo, Spain
Gordillo J:
Gastroenterology Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
Puig I:
Gastroenterology Department, Althaia, Xarxa Assistencial Universitària de Manresa, Universitat Internacional de Catalunya, Barcelona, Spain
Vega P:
Gastroenterology Department, Complexo Hospitalario Universitario de Ourense, Ourense, Spain
Bustamante-Balén M:
Gastroenterology Department, Hospital Universitario de La Fe, Valencia, Spain
Acevedo J:
Gastroenterology Department, Hospital Comarcal de Calella, Barcelona, Spain
Peñas B:
Gastroenterology Department, Hospital Ramón y Cajal, Madrid, Spain
López-Cerón M:
Gastroenterology Department, Hospital Clínic de Barcelona, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Institut d'Investigacions Biomediques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Barcelona, Spain
Ricart E:
Gastroenterology Department, Hospital Clínic de Barcelona, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Institut d'Investigacions Biomediques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Barcelona, Spain
Cuatrecasas M:
Pathology Department, Centre de Diagnostic Biomèdic (CDB), Hospital Clínic, University of Barcelona and Banc de Tumors-Biobanc Clinic-IDIBAPS-XBTC, Barcelona, Catalonia, Spain
Jimeno M:
Pathology Department, Centre de Diagnostic Biomèdic (CDB), Hospital Clínic, University of Barcelona and Banc de Tumors-Biobanc Clinic-IDIBAPS-XBTC, Barcelona, Catalonia, Spain
Pellisé M:
Gastroenterology Department, Hospital Clínic de Barcelona, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Institut d'Investigacions Biomediques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Barcelona, Spain
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