Oluseyi Akinola

A Randomized Trial Comparing High Definition Colonoscopy Alone With High Definition Dye Spraying and Electronic Virtual Chromoendoscopy for Detection of Colonic Neoplastic Lesions During IBD Surveillance Colonoscopy

Objectives:Dye spraying chromoendoscopy (DCE) is recommended for the detection of colonic neoplastic lesions in inflammatory bowel disease (IBD). The majority of neoplastic lesions are visible endoscopically and therefore targeted biopsies are appropriate for surveillance colonoscopy. To compare three different techniques for surveillance colonoscopy to detect colonic neoplastic lesions in IBD patients: high definition (HD), (DCE), or virtual chromoendoscopy (VCE) using iSCAN image enhanced colonoscopy.Methods:A randomized non-inferiority trial was conducted to determine the detection rates of neoplastic lesions in IBD patients with longstanding colitis. Patients with inactive disease were enrolled into three arms of the study. Endoscopic neoplastic lesions were classified by the Paris classification and Kudo pit pattern, then histologically classified by the Vienna classification.Results:A total of 270 patients (55% men; age range 20–77 years, median age 49 years) were assessed by HD (n=90), VCE (n=90), or DCE (n=90). Neoplastic lesion detection rates in the VCE arm was non-inferior to the DCE arm. HD was non-inferior to either DCE or VCE for detection of all neoplastic lesions. In the lesions detected, location at right colon and the Kudo pit pattern were predictive of neoplastic lesions (OR 6.52 (1.98–22.5 and OR 21.50 (8.65–60.10), respectively).Conclusions:In this randomized trial, VCE or HD-WLE is not inferior to dye spraying colonoscopy for detection of colonic neoplastic lesions during surveillance colonoscopy. In fact, in this study HD-WLE alone was sufficient for detection of dysplasia, adenocarcinoma or all neoplastic lesions.

Beyond white light: optical enhancement in conjunction with magnification colonoscopy for the assessment of mucosal healing in ulcerative colitis.

Background and study aim The I-SCAN optical enhancement (OE) system with magnification is a recently introduced combination of optical and digital electronic virtual chromoendoscopy, which enhances mucosal and vascular details. The aim of this pilot study was to investigate the use of I-SCAN OE in the assessment of inflammatory changes in ulcerative colitis (UC). Patients and methods A total of 41 consecutive patients with UC and 9 control patients were examined by I-SCAN OE (Pentax Medical, Tokyo, Japan). Targeted biopsies of the imaged areas were obtained. A new optical enhancement score focusing on mucosal and vascular changes was developed. The diagnostic accuracy of I-SCAN OE was calculated against histology using two UC histological scores - Robarts Histopathology Index (RHI) and ECAP (Extent, Chronicity, Activity, Plus additional findings). Results The overall I-SCAN OE score correlated with ECAP (r = 0.70; P < 0.001). The accuracy of the overall I-SCAN OE score to detect abnormalities by ECAP was 80 % (sensitivity 78 %, specificity 100 %). I-SCAN OE vascular and mucosal scores correlated with ECAP (r = 0.65 and 0.71, respectively; P < 0.001). The correlation between overall I-SCAN OE score and RHI was r = 0.61 (P < 0.01), and the accuracy to detect abnormalities by RHI was 68 % (sensitivity 78 %, specificity 50 %). The majority of patients with Mayo 0 had abnormalities on I-SCAN OE. Conclusion In UC, the new I-SCAN OE technology accurately identified mucosal inflammation, and correlated well with histological scores of chronic and acute changes.

Location and Kudo Pit Pattern Reflect Neoplastic Histology of Lesions Detected at Surveillance Colonoscopy in Inflammatory Bowel Disease

Introduction Effective colonoscopic surveillance of IBD benefit from having reliable predictors of neoplasia, since targeted biopsies and endoscopic resection are increasingly used as standard of practice. It is not clear whether Kudo pit patterns may be applicable in characterising IBD associated lesions. We aimed to identify the specific clinical and endoscopic features of colonic lesions which predict dysplasia in IBD. Method All lesions identified in a randomised study to determine the detection rates of neoplastic lesion (NL) in patients with long standing colitis in IBD ( NCT02098798) were included. NL were classified by the Paris classification, Kudo pit pattern, and by the Vienna classification. Univariate analysis was performed, and age, duration of disease, extra-intestinal manifestations,family or personal history of polyps/cancer, smoking, size of lesion, Paris classification, Kudo pit pattern, localization/extension were considered .Subsequently a multivariate logistic regression model analyses was created and analysed with candidate variables which had p values≤0.05 on univariate analysis. Results A total of 270 patients (55% men; median age 49y) were assessed by High Definition (n=90), virtual chromoendoscopy (n=90) or dye chromoendoscopy (n=90). Among 270 patients, ninety- one (33.7%) colonic dysplastic lesions and 1 adenocarcinoma were found. Sixty–two (68.8%) were polypoid and twenty-nine (31.8%) were non polypoid. Most of these lesions (92.3%) had Kudo pit pattern III-V. By univariate analysis, age- Odds Ratio (OR) 1.05 (95% CI:1.02–1.08), localization of the lesions in the right colon- OR 6.15 ( 95% CI: 3.12–12.12), Kudo pit pattern IIO, III-IV and V- OR 20.91 (95% CI:9.34–46.7) and Paris Is/Ip classification OR- 3.29 (95% CI 1.69–6.38) were associated with NL. Subsequently proportional multivariate logistic regression model for the prediction of colonic neoplasia confirmed that the endoscopic Kudo pit pattern- OR 21.50 (95% CI:86.5–60.1) and localization of the lesions in the right colon- OR 6.52 (95% CI:1.98–22.5) were predictors of colonic neoplasia at surveillance colonoscopy in IBD (Table). The overall accuracy of independent variables which predict neoplastic histological changes was 78% (95% CI 68%–88%), sensitivity 82% (95% CI 68%–97%), specificity 68% (95% CI 47%–89%), PPV 85% (95% CI 76%–95%) and NPV 64% (95% CI 42%–86%) which were significant in the multivariate analysis. Conclusion We demonstrated that the endoscopic Kudo pit pattern and localization of the lesions in the right colon were predictors of neoplasia in IBD. This may guide management strategy of NL detected at IBD surveillance. Disclosure of Interest M. Iacucci Conflict with: Pentax, O Akinola: None Declared, R Panaccione: None Declared, G Kaplan: None Declared, Y Leung: None Declared, K Novak: None Declared, C Seow: None Declared, X Gui: None Declared, S Urbanski: None Declared, P Minoo: None Declared, B Lethebe: None Declared, M Lowerison: None Declared, S Ghosh: None Declared