ORIGINAL ARTICLE Comparison of High Definition with Standard White Light Endoscopy for Detection of Dysplastic Lesions During Surveillance Colonoscopy in Patients with Colonic Inflammatory Bowel Disease Venkataraman Subramanian, MD, DM, MRCP(UK),* ,† Vidyasagar Ramappa, MD, MRCP(UK), † Emmanouil Telakis, MD, † Jayan Mannath, MD, MRCP(UK), † Aida U. Jawhari, PhD, FRCP, † Christopher J. Hawkey, DM, FRCP, † and Krish Ragunath, MPhil, FRCP † Background: Dysplasia in colonic inflammatory bowel disease (IBD) is often multifocal and flat. High-definition (HD) colonoscopy improves adenoma detection rates by improving the ability to detect subtle mucosal changes. The utility of HD colonoscopy in dysplasia detection in patients with IBD has not been reported so far. We aimed to compare the yield of dysplastic lesions detected by standard definition (SD) white light endoscopy with HD endoscopy. Methods: A retrospective cohort study of patients with long-standing (.7 years) colonic IBD undergoing surveillance colonoscopy at Nottingham University Hospital was studied between September 2008 and February 2010. Details of diagnosis, duration of disease, and outcomes of the colonoscopy were collected from the endoscopy database, electronic patient records, and patient notes. Results: There were 160 colonoscopies (101 ulcerative colitis [UC] and 59 Crohn’s disease [CD]) in the SD group and 209 colonoscopies (147 UC and 62 CD) in the HD group. The groups were well matched for all demographic variables. Thirty-two dysplastic lesions (27 on targeted biopsy) were detected in 24 patients in the HD group and 11 dysplastic lesions (six on targeted biopsy) were detected in eight patients the SD group. The adjusted prevalence ratio of detecting any dysplastic lesion and dysplastic lesion on targeted biopsy was 2.21 (95% confidence interval [CI] 1.09–4.45) and 2.99 (95% CI 1.16–7.79), respectively, for HD colonoscopy. Conclusions: HD colonoscopy improves targeted detection of dysplastic lesions during surveillance colonoscopy of patients with colonic IBD in routine clinical practice. Randomized controlled studies are required to confirm these findings. (Inflamm Bowel Dis 2013;19:350–355) Key Words: surveillance, UC, Crohn’s colitis, dysplasia, high definition P atients with ulcerative colitis (UC) have an increased risk for colorectal cancer (CRC) compared to the general population. 1 Cancer in UC occurs at a younger age and increases with time, approaching 18% after 30 years of disease. 1 This increased risk has prompted both the North American and UK gastroenterology societies to recommend cancer prevention strategies. 2,3 Random sampling throughout the colon has been the mainstay of conven- tional surveillance practice. Surveillance colonoscopy requires multiple biopsies to be taken and processed, which is tedious, expensive, and time-consuming. It has been estimated that at least 33 biopsies are needed to achieve 90% confidence to detect dysplasia if it is present. 4 Surveillance colonoscopy practices are not uniform and less than 10 biopsies were noted to be taken based on gastroenterologists self-reported practices for colono- scopic surveillance for UC. 5 The focus of dysplasia in UC is flat and multifocal and can be easily overlooked with conventional white light endoscopy. 6 There is growing evidence that the yield of surveillance can be improved by addition of newer endoscopic methods that enhance the detection of subtle mucosal abnormalities like chromoendoscopy (CE) and autofluorescence with narrow- band imaging (NBI). 7 CE refers to the topical application of dyes or pigments to improve detection and delineation of surface abnormalities and is an inexpensive adjunct to conventional endoscopy. It has been shown to be useful in the detection of flat adenomas in the sporadic setting as well as in patients with familial polyposis syndromes. 8,9 There is increasing Received for publication April 8, 2012; Accepted April 9, 2012. From the *Department of Gastroenterology and Leeds Institute of Molecular Medicine, St James University Hospital, Leeds, UK; and † Nottingham Digestive Diseases Centre, Nottingham University Hospital, UK. Venkataraman Subramanian was the recipient of an NIHR clinical lecturership from the National Institute of Health Research (UK). Krish Ragunath has received educational/grant support from Olympus (Keymed, UK). Reprints: Dr. Venkataraman Subramanian, Department of Gastroenterology, St James University Hospital, Leeds LS9 7TF, UK (e-mail: venkat.subramanian@ leedsth.nhs.uk). Copyright © 2013 Crohn’s & Colitis Foundation of America, Inc. DOI 10.1002/ibd.23002 Published online 2 May 2012. 350 | www.ibdjournal.org Inflamm Bowel Dis  Volume 19, Number 2, February 2013 Copyright © 2013 Crohn’s & Colitis Foundation of America, Inc. Unauthorized reproduction of this article is prohibited. Downloaded from https://academic.oup.com/ibdjournal/article/19/2/350/4604317 by guest on 28 December 2023