Introduction Detection, characterisation and therapeutic management of dysplastic lesions during surveillance colonoscopy in inflammatory bowel disease (IBD) can be a challenge. The recent SCENIC consensus has introduced a new terminology and concept “endoscopically resectable” when the distinct margins of a lesion could be identified. New endoscopic techniques and skills are required to recognise the margins reliably and assess the surrounding mucosa to plan endoscopic removal. We report our experience of the use of probe confocal endomicroscopy (pCLE) combined with electronic virtual (VCE) and dye chromoendoscopy (DCE) for management of challenging dysplastic lesions.
Method IBD patients underwent surveillance colonoscopy using high definition (HD)-iSCAN (Pentax, Japan) VCE and DCE in combination with pCLE (Cellvizio,France). pCLE was applied following injection of fluorescein 5% 10 ml to assess the histological features of the lesion, the margins and the mucosa surrounding the colonic lesion. Biopsies eventually proved dysplasia or SSA of the colonic lesions. The study was approved by the Conjoint Health Services Research Ethics Board of the University of Calgary. All patients gave informed consent.
Results Seven patients with IBD and disease duration of ≥8 years (mean age 55 years; 6 male, UC=4 CD=3) were prospectively included. They underwent surveillance colonoscopy using HD–iSCAN (Pentax EC-3940Fi; Japan). When a colonic lesion was detected, selective iSCAN -VCE was performed with or without DCE (five out of seven had DCE) with methylene blue 1% to characterise the surface, vascular pattern and the margins of the lesion. Each of the 7 patients had non polypoid colonic lesions, 4 were sessile (Paris Is) and 3 flat (IIa/IIb).All dysplastic lesions were diagnosed by pCLE and confirmed by histology. Four of them were amenable to endoscopic therapy and were successfully removed using endoscopic mucosal resection (EMR) en-block or piecemeal technique. Interestingly, one patient with multiple scattered ‘pseudopolyps’ had a 8 mm sessile pseudopolypoid lesion with a suspicious areas of SSA in the midst that was confirmed by pCLE. The endoscopic, endomicroscopic and histological findings of all the lesions were described in Table
Conclusion This case series highlights the first successful use of pCLE in combination with VCE and DCE to predict, characterise and treat colonic neoplasia in IBD. pCLE may be an additional tool to aid the endoscopist in therapeutic management by deciding endoscopic resectability versus colectomy.
Disclosure of Interest None Declared
- Confocal endomicroscopy
- inflammatory bowel disease
- electronic chromoendoscopy