Endoscopic tri-modal imaging for surveillance in ulcerative colitis: randomised comparison of high- resolution endoscopy and autofluorescence imaging for neoplasia detection; and evaluation of narrow- band imaging for classification of lesions

Van Den Broek, F. J. C.; Fockens, P.; Van Eeden, S.; Reitsma, J. B.; Hardwick, J. C. H.; Stokkers, P. C. F.; Dekker, E.
August 2008
Gut;Aug2008, Vol. 57 Issue 8, p1083
Academic Journal
Background: Endoscopic tri-modal imaging (ETMI) incorporates white light endoscopy (WLE), autofluorescence imaging (AFI) and narrow-band imaging (NBI). Aims: To assess the value of ETMI for the detection and classification of neoplasia in patients with longstanding ulcerative colitis. Design: Randomised comparative trial of tandem colonoscopies. Setting: Academic Medical Centre Amsterdam, Netherlands. Patients and methods: Fifty patients with ulcerative colitis underwent surveillance colonoscopy with ETMI. Each colonic segment was inspected twice, once with AFI and once with WLE, in random order. All detected lesions were inspected by NBI for Kudo pit pattern analysis and additional random biopsies were taken. Main outcome measures: Neoplasia miss-rates of AFI and WLE, and accuracy of the Kudo classification by NBI. Results: Among patients assigned to inspection with AFI first (n = 25), 10 neoplastic lesions were primarily detected. Subsequent WLE detected no additional neoplasia. Among patients examined with WLE first (n = 25), three neoplastic lesions were detected; subsequent inspection with AFI added three neoplastic lesions. Neoplasia miss-rates for AFI and WLE were 0% and 50% (p = 0.036). The Kudo classification by NBI had a sensitivity and specificity of 75% and 81%; however, all neoplasia was coloured purple on AFI (sensitivity 100%). No additional patients with neoplasia were detected by random biopsies. Conclusion: Autofluorescence imaging improves the detection of neoptasia in patients with ulcerative colitis and decreases the yield of random biopsies. Pit pattern analysis by NBI has a moderate accuracy for the prediction of histology, whereas AFI colour appears valuable in excluding the presence of neoplasia.


Related Articles

  • Gastroduodenitis associated with ulcerative colitis. Hori, Kazutoshi; Ikeuchi, Hiroki; Nakano, Hiroki; Uchino, Motoi; Tomita, Toshihiko; Ohda, Yoshio; Hida, Nobuyuki; Matsumoto, Takayuki; Fukuda, Yoshihiro; Miwa, Hiroto // Journal of Gastroenterology;2008, Vol. 43 Issue 3, p193 

    Ulcerative colitis (UC) is regarded as confined to the colorectum; however, there are several case reports showing upper gastrointestinal involvement. The aim of this study was to examine the prevalence and characteristics of gastroduodenitis associated with UC (GDUC). Esophagogastroduodenoscopy...

  • Pitfalls in the Interpretation of Nonneoplastic Mucosal Biopsies in Inflammatory Bowel Disease. Yantiss, Rhonda K.; Odze, Robert D. // American Journal of Gastroenterology;Apr2007, Vol. 102 Issue 4, p890 

    This review provides a summary of common diagnostic problems encountered by both pathologists and gastroenterologists when evaluating patients with diarrhea and in whom inflammatory bowel disease (IBD) is suspected. The two most common forms of IBD, ulcerative colitis (UC) and Crohn's disease...

  • VSL#3 Probiotic-Mixture Induces Remission in Patients with Active Ulcerative Colitis. Bibiloni, Rodrigo; Fedorak, Richard N.; Tannock, Gerald W.; Madsen, Karen L.; Gionchetti, Paolo; Campieri, Massimo; De Simone, Claudio; Sartor, R. Balfour // American Journal of Gastroenterology;Jul2005, Vol. 100 Issue 7, p1539 

    BACKGROUND AND AIMS : Intestinal bacteria have been implicated in the initiation and perpetuation of IBD; in contrast, “probiotic bacteria” have properties possibly effective in treating and preventing relapse of IBD. We evaluated the safety and efficacy of VSL#3 and the components,...

  • Preferential Induction of Peripheral Lymph Node Addressin on High Endothelial Venule-Like Vessels in the Active Phase of Ulcerative Colitis. Suzawa, Kenichi; Kobayashi, Motohiro; Sakai, Yasuhiro; Hoshino, Hitomi; Watanabe, Matsuko; Harada, Oi; Ohtani, Haruo; Fukuda, Minoru; Nakayama, Jun // American Journal of Gastroenterology;Jul2007, Vol. 102 Issue 7, p1499 

    OBJECTIVES: In the colonic mucosa with ulcerative colitis (UC), it has been suggested that L-selectin-peripheral lymph node addressin (PNAd) interaction plays a role in lymphocyte recruitment, which requires PNAd induction on high endothelial venule (HEV)-like vessels. The present study was...

  • Dramatic And Long Lasting Efficiency (13 Years) Of Oral 5 Aspirin. Maroy, Bernard // Internet Journal of Academic Physician Assistants;2003, Vol. 3 Issue 1, p12 

    Introduction: Could 5 ASA be an option in case of cortico-resistant and/or intolerant ulcerative colitis? Case report: A 55-year-old woman was referred for a recent, moderately severe, left-sided ulcerative colitis. The response to corticotherapy was initially fair, then mediocre, complicated by...

  • The Microvacular Thrombi of Colonic Tissue in Ulcerative Colitis. Guobin He; Qin Ouyang; Daiyun Chen; Fengyuan Li; Jingguo Zhou // Digestive Diseases & Sciences;Sep2007, Vol. 52 Issue 9, p2236 

    Abstract  Mucosal microvacular thrombi in rectal biopsies were observed in some ulcerative colitis (UC). Heparin may be effective in steroid resistant UC in some studies, however, the new results of meta-analysis demonstrated a non-significant effect of heparin in controlled...

  • The Role of Zinc and Metallothionein in the Dextran Sulfate Sodium-Induced Colitis Mouse Model. C. Tran; S. Sundar; P. Coyle // Digestive Diseases & Sciences;Sep2007, Vol. 52 Issue 9, p2113 

    Abstract  Zinc (Zn) and its binding protein metallothionien (MT) have been proposed to suppress the disease activity in ulcerative colitis. To determine the role of Zn and MT in the dextran sulfate sodium (DSS)-induced model of colitis in mice, a DSS dose-response study was...

  • Leukocytapheresis (LCAP) in the Management of Chronic Active Ulcerative Colitis—Results of a Randomized Pilot Trial. Jörg Emmrich; Sebastian Petermann; Dietrich Nowak; Ingolf Beutner; Peter Brock; Patrick Mausfeld-Lafdhiya; Stefan Liebe; Wolfgang Ramlow // Digestive Diseases & Sciences;Sep2007, Vol. 52 Issue 9, p2044 

    Abstract  Recent studies suggest that leukocytapheresis with Cellsorba is a valuable therapy for ulcerative colitis after failure of conventional treatment. In this study the potential of leukocytapheresis to induce remission in refractory chronic colitis under the conditions of...

  • Meta-Analysis of the Placebo Response in Ulcerative Colitis. Sagar Garud; Alphonso Brown; Adam Cheifetz; Emily Levitan; Ciaran Kelly // Digestive Diseases & Sciences;Apr2008, Vol. 53 Issue 4, p875 

    Abstract   Purpose The placebo response rate in randomized controlled trials (RCTs) in ulcerative colitis (UC) varies from 0 to 76%. The aims of this study were to quantify the pooled placebo response rate and identify the factors affecting it. Methods We performed a...


Read the Article


Sign out of this library

Other Topics