Original article
Clinical endoscopy
Narrow-band imaging as an alternative to chromoendoscopy for the detection of dysplasia in long-standing inflammatory bowel disease: a prospective, randomized, crossover study

https://doi.org/10.1016/j.gie.2011.05.013Get rights and content

Background

Narrow-band imaging (NBI) is a novel technique that may represent an alternative method to chromoendoscopy (CE) for the detection of colitis-associated intraepithelial neoplasia (IN) in patients with long-standing inflammatory bowel disease (IBD).

Objective

To compare NBI with CE for the detection of IN.

Design

Prospective, randomized, crossover study.

Setting

Academic hospital.

Patients

Patients with clinically inactive colonic IBD (≥8 years).

Intervention

Patients underwent both CE and NBI in randomized order. Targeted biopsy specimens from abnormal areas were obtained. Pathological examination was regarded as the reference standard.

Main Outcome Measurements

Number of false-positive and true-positive lesions in patients undergoing CE and NBI were compared as well as the proportion of patients with missed IN lesions.

Results

Eighty patients were screened, of whom 20 were excluded. Mean ± standard deviation withdrawal time for CE was significantly longer than that for NBI (26.87 ± 9.89 minutes vs 15.74 ± 5.62 minutes, P < .01). Thirteen patients had at least 1 IN lesion on 1 of the examinations. In the per-lesion analysis, NBI resulted in a significantly inferior false-positive biopsy rate (P = .001) and a similar true-positive rate. The percentage of missed IN lesions and patients was superior with NBI, albeit without reaching statistical significance.

Limitations

Lesions were sampled immediately after detection, which precluded the possibility of paired analysis.

Conclusions

NBI appears to be a less time-consuming and equally effective alternative to CE for the detection of IN. However, given the NBI lesion and patient miss rates, it cannot be recommended as the standard technique.

Section snippets

Patients

Consecutive patients with clinically inactive, long-standing UC (≥8 years) involving at least the left colon or patients with colonic Crohn's disease (CD) affecting at least one third of the colon (≥8 years) were recruited from the Outpatient Clinic of the Gastroenterology Department at Hospital Clinic, Barcelona, Spain. Patients were excluded if they had previous colorectal cancer, a previous surgical resection of the colon or rectum, coagulopathy, a known allergy to indigo carmine, or if they

Patient characteristics

Between April 2006 and November 2007, a total of 80 patients fulfilled inclusion criteria and were enrolled in this study. Twenty patients had to be excluded from further analysis because either 1 or both procedures was incomplete because of poor or fair bowel preparation (n = 6), endoscopic activity (n = 11), or lack of agreement (n = 3) (Fig. 1). Our analysis was therefore restricted to 60 patients for whom paired colonoscopic procedural data were available. CE was the first study performed

Discussion

To our knowledge, this is the first prospective, randomized study to compare the effectiveness of NBI compared with CE for the detection of IN in patients with long-standing colonic IBD. In this study, we provide evidence supporting the use of NBI as a novel method for detecting dysplasia in this patient population.

In this series, we included patients with extensive colonic CD as well as individuals with UC. In both cases, only lesions located in colitic areas were considered. Interestingly,

References (32)

  • J.E. East et al.

    Look, remove, and discard: can narrow-band imaging replace histopathology for small colorectal polyps?It is time to push the button!

    Gastrointest Endosc

    (2007)
  • D.K. Rex et al.

    Colonoscopic miss rates of adenomas determined by back-to-back colonoscopies

    Gastroenterology

    (1997)
  • M.D. Rutter et al.

    Thirty-year analysis of a colonoscopic surveillance program for neoplasia in ulcerative colitis

    Gastroenterology

    (2006)
  • M. Rutter et al.

    Endoscopic appearance of dysplasia in ulcerative colitis and the role of staining

    Endoscopy

    (2004)
  • M.D. Rutter et al.

    Pancolonic indigo carmine dye spraying for the detection of dysplasia in ulcerative colitis

    Gut

    (2004)
  • D.P. Hurlstone et al.

    Indigo carmine-assisted high- magnification chromoscopic colonoscopy for the detection and characterisation of IN in ulcerative colitis: a prospective evaluation

    Endoscopy

    (2005)
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    DISCLOSURE: The following author disclosed a financial relationship relevant to this publication: Cristina Rodríguez de Miguel is a research nurse supported by Olympus Medical Systems, Europe. The other authors disclosed no financial relationships relevant to this publication. This work was supported in part by grants from the Fondo de Investigaciones Sanitarias (FIS Proyectos de Evaluación de Tecnologías Sanitarias PI07/90174- M.P). Maria López Cerón is a research fellow from the FIS (Rio Hortega contract). The Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD) is funded by the Instituto de Salud Carlos III. Prototype endoscopic equipment was supplied by Olympus Medical Systems, Europe.

    If you would like to chat with an author of this article, you may contact Dr. Pellisé at [email protected].

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