A multi-centre randomised controlled trial on virtual chromoendoscopy in the neoplasia detection during colitis surveillance HDTV colonoscopy (VIRTUOSO Trial)

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Authors

Colleges, School and Institutes

Abstract

BACKGROUND:
Longstanding colonic inflammatory bowel disease (IBD) increases the risk of developing colorectal cancer. On contrast to conventional chromoendoscopy with standard definition white light technology the use of high definition virtual chromoendoscopy (HDV) in colitis surveillance is yet to be defined.

OBJECTIVE:
To compare the performance of HDV (i-scan OE Mode 2) with high definition white light (HDWL) for detection of neoplasia in IBD patients undergoing surveillance colonoscopy. We also wanted to assess the additional gain of protocol guided quadrantic non-targeted biopsies.

DESIGN:
A multi-operator randomised controlled trial was carried out in two centres in the United Kingdom. 188 patients (xx men, mean age xx) with long standing ulcerative or Crohn’s colitis (mean disease duration xx years) were randomised, prior to starting the surveillance colonoscopy, to using either HDV (n=94) or HDWL (n=94) on withdrawal. Targeted and quadrantic non-targeted biopsies were taken in both arms per randomisation protocol. Main outcome was xxx

RESULTS: please consider using intraepithelial neoplasia (low/high grade) instead of adenoma, also in text
There was no significant difference between HDWL and HDV for neoplasia detection. The neoplasia detection rate (NDR) was not significantly different for HDWL (24.2%) and HDV (14.9%) (p=0.14). All adenomas detected contained low-grade dysplasia only. Only 1 of the 52 neoplasias was detected by non-targeted biopsies. A total of 6751 non-targeted biopsies detected 1 adenoma only. The withdrawal time was similar in both arms of the study; median of 24 minutes (HDWL) vs 25.5 minutes (HDV).

CONCLUSION:
In the setting of high definition colonoscopy virtual chromoendoscopy did not significantly improve the detection of neoplasia. Almost all neoplasia were found on targeted biopsy or resection. Quadrantic non-targeted biopsies had negligible additional gain in our study.

KEYWORDS: inflammatory bowel disease, dysplasia surveillance, endoscopy, ulcerative colitis, Crohn’s colitis, colonoscopy, endoscopic procedures

Details

Original languageEnglish
JournalGut
Publication statusAccepted/In press - 17 Sep 2020