Rutter, M.D.; Schofield, G.; Price, A.B.; Talbot, I.C.; Saunders, B.P.
April 2003
Gut;Apr2003 Supplement 1, Vol. 52, pA6
Academic Journal
Background and Aim: Patients with longstanding extensive ulcerative colitis (UC) are at increased risk of colorectal cancer. Colonoscopic surveillance is often performed, and relies heavily on multiple non-targeted mucosal biopsies detecting occult dysplasia. Chromoendoscopy can aid detection of subtle mucosal abnormalities. We hypothesised that the routine use of pan-colonic indigo carmine dye spray would improve the macroscopic detection of dysplasia while reducing the dependence on non-targeted biopsies. Methods: One hundred patients with longstanding extensive UC attending for colonoscopic surveillance underwent "back-to-back" same day colonoscopies. During the first examination, all visible abnormalities were biopsied and quadrantic, non-targeted biopsies were taken every 10 cm throughout the colon and rectum (20-40 biopsies per patient). Indigo carmine dye (0.1%) was used to coat the entire mucosal surface during the second colonoscopic withdrawal, and additional abnormalities detected with dye spray were biopsied. Results: Extubation times for first and second colonoscopies were 11 and 10 min, respectively. Forty three mucosal abnormalities (from 20 patients) were detected by pre-dye spray targeted b opsies and following indigo carmine dye-spraying 114 additional abnormalities (in 55 patients) were detected. Pre-dye spray targeted b opsies detected two lesions considered to be dysplasia associated lesions/masses (DALMs) in two patients. Dye spraying detected seven additional dysplastic lesions/2-6 mm) in five patients. All seven were considered histologically and colonoscopically to be sporadic adenomas. No dysplasia was detected in 2904 non-targeted biopsies. Conclusions: Pan-colonic indigo carmine dye spraying increased the yield of suspicious mucosal areas, but the vast majority of these (107/114) were nondysplastic. No dysplasia was detected from 2904 non-targeted biopsies. Chromoendoscopy may be more time-effective than taking high numbers of...


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