Copyright
©The Author(s) 2018. Published by Baishideng Publishing Group Inc. All rights reserved.
Real-life chromoendoscopy for dysplasia surveillance in ulcerative colitis
Pasquale Klepp, Anita Tollisen, Arne Røseth, Milada Cvancarova Småstuen, Solveig N Andersen, Morten Vatn, Bjørn A Moum, Stephan Brackmann
Pasquale Klepp, Anita Tollisen, Arne Røseth, Unger-Vetlesen Institute, Department of Internal Medicine, Lovisenberg Diaconal Hospital, Oslo 0456, Norway
Pasquale Klepp, Milada Cvancarova Småstuen, Morten Vatn, Bjørn A Moum, Stephan Brackmann, Institute of Clinical Medicine, University of Oslo, Oslo 0317, Norway
Solveig N Andersen, Department of Pathology, Akershus University Hospital, Lørenskog 1474, Norway
Bjørn A Moum, Department of Gastroenterology, Oslo University Hospital, Oslo 0450, Norway
Stephan Brackmann, Department of Gastroenterology, Akershus University Hospital, Lørenskog 1474, Norway
Author contributions: Klepp P contributed to acquisition, analysis and interpretation of the data, and drafting and revision of the manuscript; Tollisen A contributed to planning and collection of the data; Røseth A contributed to conception and design of the study, and performed critical revision of the manuscript for important intellectual content; Cvancarova Småstuen M contributed to the statistical analysis and critical revision of the manuscript for important intellectual content; Andersen SN provided technical support and contributed to revision of the histopathological material; Vatn M provided critical revision of the manuscript for important intellectual content and performed study supervision; Moum BA and Brackmann S contributed to conception and design of the study, and performed critical revision of the manuscript for important intellectual content and study supervision; all authors have approved the final draft.
Supported by the Unger-Vetlesen Institute, Department of Internal Medicine, Lovisenberg Hospital.
Institutional review board statement: The study protocol was designed according to the combined knowledge and expertise of Assistant Professor Stephan Brackmann (Akershus University Hospital), Professor Bjørn A Moum (Oslo University Hospital) and Professor Morten Vatn (University of Oslo). The study protocol was approved by the Regional Committee for Medical and Health Research Ethics (REC Project NO. 2010/1093).
Informed consent statement: Written informed consent was collected from subjects prior to study inclusion.
Conflict-of-interest statement: The authors have no conflicts of interest.
Data sharing statement: No additional data are available.
STROBE statement: The authors have read the STROBE Statement, and the manuscript was prepared and revised according to the STROBE Statement.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Pasquale Klepp, MD, Attending Doctor, Department of Internal Medicine, Lovisenberg Hospital, Lovisenberggt.17, Oslo 0456, Norway.
pasklepp@gmail.com
Telephone: +47-23225000
Received: May 30, 2018
Peer-review started: May 30, 2018
First decision: July 4, 2018
Revised: August 6, 2018
Accepted: August 24, 2018
Article in press: August 24, 2018
Published online: September 21, 2018
Processing time: 113 Days and 17.7 Hours
ARTICLE HIGHLIGHTS
Research background
Patients with longstanding and extensive ulcerative colitis carry an increased risk of developing colonic neoplasia and are advised to undergo regular colonoscopic surveillance.
Research motivation
The current clinical guidelines favour chromoendoscopy with targeted biopsies for dysplasia surveillance of ulcerative colitis. These recommendations, however, are based on studies performed in advanced endoscopic units and chromoendoscopy is not routinely applied in everyday clinical practice.
Research objectives
Our aim was to evaluate chromoendoscopy for real-life dysplasia surveillance for cases of long-standing ulcerative colitis in a community hospital.
Research methods
Patients with extensive ulcerative colitis, with disease duration of more than 8 years, were prospectively included in this single cohort study. The chromoendoscopies were performed by two expert endoscopists novice to the method. Lesions were evaluated macroscopically and removed and/or biopsied. Nontargeted biopsies were also taken from each segment of the colon.
Research results
A total of 21 neoplastic lesions (consisting of 2 carcinomas, 4 high-grade dysplasias and 15 low-grade dysplasias) and 27 nondysplastic lesions were detected in 16 of the 67 total patients included in the study. The dysplasia detection rate was 10.5% (for 7 of the 67 patients). The dysplasia detection yield was 20.8% (10/48) for targeted biopsies and 3.5% (11/318) for nontargeted biopsies. The endoscopists accurately evaluated the absence of neoplasia (specificity of 96%, with 95% confidence interval of 93-98; and a negative predictive value of 97%, with 95% confidence interval of 95%-98%).
Research conclusions
Although novice to chromoendoscopy, the endoscopists in this Norwegian community hospital accurately evaluated the absence of neoplasia. In addition, the yield of nontargeted biopsies was negligible.
Research perspectives
Chromoendoscopy appears to be of value for dysplasia surveillance for cases of long-standing ulcerative colitis who are treated in a community hospital setting in which endoscopists are novice to the technique.
