Due to the large number of biopsy specimens, surveillance colonoscopy in ulcerative colitis is currently time consuming, and significant flat lesions still may be missed.
Dr Ralf Kiesslich and colleagues from Germany assessed the value of combined chromoscopy and endomicroscopy for the diagnosis of intra-epithelial neoplasias in a randomized controlled trial.
The team randomized a total of 161 patients with long-term ulcerative colitis in clinical remission.
The patients were randomized to undergo either conventional colonoscopy or chromoscopy with endomicroscopy.
|Endomicroscopy detected 5-fold more neoplasias|
The researchers randomized 73 patients to Group 1.
Patients in Group 1 underwent conventional colonoscopy, random biopsy examinations and targeted biopsy examinations.
In Group 2, 80 patients were randomized to receive endomicroscopy.
Circumscribed mucosal lesions were identified by chromoscopy, and evaluated for targeted biopsy examination by endomicroscopy.
The researchers excluded 8 patients because of insufficient bowel preparation.
The primary outcome analysis was based on the detection of neoplasia, justified by using chromoscopy with endomicroscopy.
The researchers detected 5-fold more neoplasias with microscopy than with conventional colonoscopy.
However, the team observed that 50% fewer biopsy specimens were required.
If only circumscribed lesions would have been biopsied in the first group, the total number of biopsy specimens could have been reduced by more than 90%.
A total of 5580 confocal endomicroscopic images from 134 circumscribed lesions were compared with histologic results.
The researchers noted that the presence of neoplastic changes could be predicted by endomicroscopy with high accuracy.
The team found that the sensitivity and specificity was 95% and 98%, respectively.
The research team noted that the accuracy was 98%.
Dr Kiesslich's team concluded, “Endomicroscopy based on in vivo histology can determine if ulcerative colitis lesions identified by chromoscopy should undergo biopsy examination.”
“This increases the diagnostic yield and reducing the need for biopsy examinations.”
“Thus, chromoscopy-guided endomicroscopy may lead to significant improvements in the clinical management of ulcerative colitis.”