TOPLINE

Virtual chromoendoscopy (VCE) based on linked color imaging (LCI) showed comparable performance to traditional dye-based chromoendoscopy (DCE) in detecting neoplastic lesions in patients with long-standing colonic inflammatory bowel disease (IBD) who underwent surveillance colonoscopy for colorectal cancer (CRC), with VCE requiring a shorter withdrawal time.

METHODOLOGY

• Although DCE performed using high-definition colonoscopes can improve the detection of lesions, its uptake remains low among endoscopists due to the time and cost involved. Dye-free VCE has emerged as a faster, cheaper alternative that enhances mucosal contrast; the use of LCI-based advanced VCE has improved the detection of adenomas in individuals without IBD, but its performance in patients with IBD remains unclear.
• Researchers conducted a single-center retrospective cohort study involving 311 patients (mean age, 47.8 years; 53.7% men) with long-standing colonic IBD (≥ 8 years after the onset of symptoms) who underwent surveillance colonoscopy for CRC, to compare the performance of LCI and DCE in detecting colonic neoplastic lesions.
• Of the included patients, 199 underwent LCI and 112 underwent DCE; all procedures were performed using high-definition colonoscopes by three expert endoscopists. In DCE, 0.04% methylene blue was applied via a spray catheter to stain each colonic segment, and LCI was activated and maintained throughout withdrawal.
• The primary outcome was the detection of total neoplastic lesions, including colitis-associated dysplasia, adenocarcinoma, sporadic adenoma, and serrated lesions, using targeted biopsies or polypectomy; researchers also determined the rate of neoplastic lesion detection, defined as the proportion of colonoscopies with at least one neoplastic lesion.
• Propensity score matching and other statistical analyses were used to adjust for baseline differences and identify independent predictors of neoplastic lesions.

TAKEAWAY

• Overall, 30 neoplastic lesions were detected. The mean number of lesions identified per colonoscopy was similar between the DCE and LCI groups (0.116 vs 0.085; P =.472), and the rate of neoplastic lesion detection was also comparable (8.03% vs 7.53%; P = .874).
• Among 208 matched patients (104 DCE vs 104 LCI), chromoendoscopy type was not associated with the total number of neoplastic lesions (P = .543) or the rate of neoplastic lesion detection (P = .310), supporting comparable performance of LCI and DCE.
• Longer disease duration (adjusted incidence rate ratio [IRR], 1.05 per year; odds ratio [OR], 1.06 per year) and a first-degree family history of CRC (adjusted IRR, 3.64; OR, 4.43) were independently associated with a higher count and detection rate of neoplastic lesions (P < .05 for both).
• DCE required a longer withdrawal time than LCI (17.47 min vs 14.21 min; P < .0001).

IN PRACTICE

“By applying LCI-based VCE in a real-world setting, our study provides validation of its equivalence to dye-based chromoendoscopy,” the authors of the study wrote.

“Within HD [high definition] endoscopic systems and structured surveillance programs, the choice of chromoendoscopy modality appears less critical than established risk factors such as disease duration and family history of colorectal cancer,” they added.

SOURCE

The study was led by Roberto Gabbiadini, IRCCS Humanitas Research Hospital in Rozzano, Milan, Italy. It was published online in the Journal of Crohn’s and Colitis.

LIMITATIONS

The retrospective, nonrandomized study design may have introduced residual confounding and selection bias. All procedures were performed exclusively by expert endoscopists, which may have limited the results’ generalizability to lower-volume centers and general gastroenterology practice. The overall count of neoplastic lesions was small, which limited the statistical power to detect small differences between the chromoendoscopy techniques.

DISCLOSURES

No funding was declared for this study. Several authors disclosed receiving speaker’s fees, consulting or advisory board fees, lecture fees and/or fees for serving on speakers bureau, and research grants from various biopharmaceutical and medical device companies.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.