Dye Enhances Surveillance Colonoscopy in Patients With Ulcerative Colitis

Does dye-based chromoendoscopy improve dysplasia detection in patients undergoing surveillance colonoscopy for long-term ulcerative colitis?

It does, according to Anna Buchner, MD, PhD, at the University of Pennsylvania in Philadelphia, and her coauthors, and this raises the question of whether US guidelines should endorse dye-based chromoendoscopy for dysplasia screening in patients with ulcerative colitis.

The current US standard of care for early colon cancer detection in ulcerative colitis is periodic standard (white light) colonoscopy (WLE), with surveillance biopsy of random flat surfaces, and of raised lesions. Surveillance colonoscopy can detect dysplasia, a histologic precursor to colon cancer. Dye-based chromoendoscopy may represent an opportunity for improved detection of dysplasia and is supported by several European GI societies and the Crohn’s and Colitis Foundation of America. By accentuating the visual appearance of dysplasia, dye allows the endoscopist to more accurately choose abnormal-appearing tissue for biopsy.

Dr Buchner presented a meta-analysis of 6 relevant studies, encompassing 1584 patients with ulcerative colitis, which demonstrated that dye-based chromoendoscopy improves the case-finding rate for dysplasia in surveillance colonoscopic biopsy of patients with ulcerative colitis. The results suggest that cancer prevention in patients with ulcerative colitis would be augmented by adding dye-based chromoendoscopy, which had nearly a 3-fold likelihood of detecting dysplasia compared with standard WLE.

This meta-analysis was a 2010 ACG/Centocor IBD Abstract Award Winner.