Department of Gastroenterology and Hepatology, University Medical Center Utrecht, Utrecht, The Netherlands.
Department of Gastroenterology and Hepatology, Leiden University Medical Center, Leiden, The Netherlands.
Am J Gastroenterol. 2015 Jul;110(7):1014-21. doi: 10.1038/ajg.2015.63. Epub 2015 Mar 31.
Randomized trials demonstrated that chromoendoscopy is superior to white light endoscopy with random biopsy sampling (WLE) for the detection of dysplasia in patients with inflammatory bowel disease (IBD). Whether implementing chromoendoscopy can increase the detection of dysplasia in clinical practice is unknown.
Patients with ulcerative colitis (UC) and Crohn's disease (CD) undergoing colonoscopic surveillance between January 2000 and November 2013 in three referral centers were identified using the patients' medical records. In recent years, the use of high-definition chromoendoscopy was adopted in all three centers using segmental pancolonic spraying of 0.1% methylene blue or 0.3% indigo carmine (chromoendoscopy group). Previously, surveillance was performed employing WLE with random biopsies every 10 cm (WLE group). The percentage of colonoscopies with dysplasia was compared between both groups.
A total of 440 colonoscopies in 401 patients were performed using chromoendoscopy and 1,802 colonoscopies in 772 patients using WLE. Except for a higher number of CD patients with extensive disease and more patients with a first-degree relative with colorectal cancer (CRC) in the chromoendoscopy group, the known risk factors for IBD-associated CRC were comparable between both groups. Dysplasia was detected during 48 surveillance procedures (11%) in the chromoendoscopy group as compared with 189 procedures (10%) in the WLE group (P=0.80). Targeted biopsies yielded 59 dysplastic lesions in the chromoendoscopy group, comparable to the 211 dysplastic lesions detected in the WLE group (P=0.30).
Despite compelling evidence from randomized trials, implementation of chromoendoscopy for IBD surveillance did not increase dysplasia detection compared with WLE with targeted and random biopsies.
随机试验表明，与随机活检取样的白光内镜（WLE）相比，色素内镜（chromoendoscopy）在检测炎症性肠病（IBD）患者的异型增生方面更具优势。但在临床实践中实施色素内镜是否能增加异型增生的检出率尚不清楚。
通过患者病历，确定了 2000 年 1 月至 2013 年 11 月在三个转诊中心接受结肠镜监测的溃疡性结肠炎（UC）和克罗恩病（CD）患者。近年来，三个中心均采用高清色素内镜，对全结肠进行分段黏膜喷洒 0.1%亚甲蓝或 0.3%靛胭脂（chromoendoscopy 组）。在此之前，采用 WLE 进行监测，每 10cm 进行随机活检（WLE 组）。比较两组中异型增生结肠镜检查的比例。
共对 401 例患者的 440 次结肠镜检查采用 chromoendoscopy，对 772 例患者的 1802 次结肠镜检查采用 WLE。与 chromoendoscopy 组相比，WLE 组 CD 患者广泛疾病较多，有一级亲属结直肠癌（CRC）的患者更多，但两组的 IBD 相关 CRC 已知危险因素相当。chromoendoscopy 组有 48 次监测过程（11%）检出异型增生，而 WLE 组有 189 次（10%）（P=0.80）。chromoendoscopy 组靶向活检检出 59 个异型增生病变，与 WLE 组检出的 211 个异型增生病变相当（P=0.30）。
尽管随机试验提供了有力证据，但与靶向和随机活检的 WLE 相比，在 IBD 监测中实施 chromoendoscopy 并未增加异型增生的检出率。
