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Original article
Real-life chromoendoscopy for neoplasia detection and characterisation in long-standing IBD
  1. Sabela Carballal1,
  2. Sandra Maisterra2,
  3. Antonio López-Serrano3,
  4. Antonio Z Gimeno-García4,
  5. María Isabel Vera5,
  6. José Carlos Marín-Garbriel6,
  7. José Díaz-Tasende6,
  8. Lucía Márquez7,
  9. Marco Antonio Álvarez7,
  10. Luis Hernández8,
  11. Luisa De Castro9,
  12. Jordi Gordillo10,
  13. Ignasi Puig11,
  14. Pablo Vega12,
  15. Marco Bustamante-Balén13,
  16. Juan Acevedo14,
  17. Beatriz Peñas15,
  18. María López-Cerón1,
  19. Elena Ricart1,
  20. Miriam Cuatrecasas16,
  21. Mireya Jimeno16,
  22. María Pellisé1
  23. on behalf of the EndoCAR group of the Spanish Gastroenterological Association and Spanish Digestive Endoscopy Society
  1. 1Gastroenterology Department, Hospital Clínic de Barcelona, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Institut d'Investigacions Biomediques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Barcelona, Spain
  2. 2Gastroenterology Department, Hospital Universitario de Bellvitge, Hospitalet de Llobregat, Barcelona, Spain
  3. 3Gastroenterology Department, Hospital Universitari Dr. Peset, Valencia, Spain
  4. 4Gastroenterology Department, Hospital Universitario de Canarias, La Laguna, Spain
  5. 5Gastroenterology Department, Hospital Puerta del Hierro, Madrid, Spain
  6. 6Gastroenterology Department, Hospital Universitario 12 de Octubre, Madrid, Spain
  7. 7Gastroenterology Department, Hospital del Mar, Barcelona, Spain
  8. 8Digestive Disease Section, Hospital Universitario de Móstoles, Madrid, Spain
  9. 9Gastroenterology Department, Complexo Hospitalario Universitario de Vigo, Instituto de Investigación Biomédica. Estructura Organizativa de Xestión Integrada de Vigo, Vigo, Spain
  10. 10Gastroenterology Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
  11. 11Gastroenterology Department, Althaia, Xarxa Assistencial Universitària de Manresa, Universitat Internacional de Catalunya, Barcelona, Spain
  12. 12Gastroenterology Department, Complexo Hospitalario Universitario de Ourense, Ourense, Spain
  13. 13Gastroenterology Department, Hospital Universitario de La Fe, Valencia, Spain
  14. 14Gastroenterology Department, Hospital Comarcal de Calella, Barcelona, Spain
  15. 15Gastroenterology Department, Hospital Ramón y Cajal, Madrid, Spain
  16. 16Pathology Department, Centre de Diagnostic Biomèdic (CDB), Hospital Clínic, University of Barcelona and Banc de Tumors-Biobanc Clinic-IDIBAPS-XBTC, Barcelona, Catalonia, Spain
  1. Correspondence to Dr María Pellisé, Department of Gastroenterology and Endoscopy, Hospital Clínic, Villarroel 170, Barcelona, Catalonia 08036, Spain; mpellise{at}


Objective Outside clinical trials, the effectiveness of chromoendoscopy (CE) for long-standing IBD surveillance is controversial. We aimed to assess the effectiveness of CE for neoplasia detection and characterisation, in real-life.

Design From June 2012 to 2014, patients with IBD were prospectively included in a multicentre cohort study. Each colonic segment was evaluated with white light followed by 0.4% indigo carmine CE. Specific lesions' features were recorded. Optical diagnosis was assessed. Dysplasia detection rate between expert and non-expert endoscopists and learning curve were ascertained.

Results Ninety-four (15.7%) dysplastic (1 cancer, 5 high-grade dysplasia, 88 low-grade dysplasia) and 503 (84.3%) non-dysplastic lesions were detected in 350 patients (47% female; mean disease duration: 17 years). Colonoscopies were performed with standard definition (41.5%) or high definition (58.5%). Dysplasia miss rate with white light was 40/94 (57.4% incremental yield for CE). CE-incremental detection yield for dysplasia was comparable between standard definition and high definition (51.5% vs 52.3%, p=0.30). Dysplasia detection rate was comparable between expert and non-expert (18.5% vs 13.1%, p=0.20). No significant learning curve was observed (8.2% vs 14.2%, p=0.46). Sensitivity, specificity, and positive and negative predictive values for dysplasia optical diagnosis were 70%, 90%, 58% and 94%, respectively. Endoscopic characteristics predictive of dysplasia were: proximal location, loss of innominate lines, polypoid morphology and Kudo pit pattern III–V.

Conclusions CE presents a high diagnostic yield for neoplasia detection, irrespectively of the technology and experience available in any centre. In vivo, CE optical diagnosis is highly accurate for ruling out dysplasia, especially in expert hands. Lesion characteristics can aid the endoscopist for in situ therapeutic decisions.

Trial registration number NCT02543762.

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