Background Colonoscopy with pan-chromoendoscopy (CE) is superior to standard colonoscopy in detecting neoplasia in patients with IBD. Performing random biopsies in unsuspicious mucosa after CE remains controversial.
Methods Consecutive patients with IBD who underwent surveillance colonoscopy using CE were prospectively included. The standardised procedure used CE, performed targeted biopsies or endoscopic resection on suspicious lesions and then quadrant random biopsies every 10 cm. A panel of five expert pathologists reviewed histological slides with dysplasia. Logistic regression model was used to evidence the factors associated with neoplasia in any or in random biopsies.
Results 1000 colonoscopes were performed in 1000 patients (495 UC, 505 Crohn's colitis). In 82 patients, neoplasia was detected from targeted biopsies or removed lesions, and among them dysplasia was detected also by random biopsies in 7 patients. Importantly, in 12 additional patients dysplasia was only detected by random biopsies. Overall, 140 neoplastic sites were found in 94 patients, 112 (80%) from targeted biopsies or removed lesions and 28 (20%) by random biopsies. The yield of neoplasia by random biopsies only was 0.2% per-biopsy (68/31 865), 1.2% per-colonoscopy (12/1000) but 12.8% per-patient with neoplasia (12/94). Dysplasia detected by random biopsies was associated with a personal history of neoplasia, a tubular appearing colon and the presence of primary sclerosing cholangitis (PSC).
Conclusions Despite their low yield, random biopsies should be performed in association with CE in patients with IBD with a personal history of neoplasia, concomitant PSC or a tubular colon during colonoscopy.
Trial registration number IRB 001508, Paris 7 University.
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Contributors DM, MA, DL, J-MR, PM, J-FC, A-LC, SN, YB, FB designed and performed the study, analysed the data and wrote the manuscript. XT, AB, HB, J-MG, CS, JM, A-LP, FC, PS, MS performed the study and were involved in the critical revision of the manuscript. DC-H, PB, A-LV, J-FF, FB reviewed slides with neoplasia and revised the manuscript critically for important intellectual content.
Funding The study was supported by the Association François Aupetit, the Société Nationale Française de Gastro-Entérologie, and by a research grant from Ferring.
Competing interests None declared.
Patient consent Obtained.
Ethics approval Institutional Review Board (IRB) of the GETAID (IRB 001508, Paris 7 University).
Provenance and peer review Not commissioned; externally peer reviewed.
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