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  • Are random biopsies still useful for the detection of neoplasia in patients with IBD undergoing surveillance colonoscopy with chromoendoscopy?

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Inflammatory bowel disease
Original article
Are random biopsies still useful for the detection of neoplasia in patients with IBD undergoing surveillance colonoscopy with chromoendoscopy?
  1. Driffa Moussata1,
  2. Matthieu Allez2,
  3. Dominique Cazals-Hatem3,
  4. Xavier Treton4,
  5. David Laharie5,
  6. Jean-Marie Reimund6,
  7. Philippe Bertheau7,
  8. Arnaud Bourreille8,
  9. Anne Lavergne-Slove9,
  10. Hedia Brixi10,
  11. Julien Branche11,
  12. Jean-Marc Gornet2,
  13. Carmen Stefanescu4,
  14. Jacques Moreau12,
  15. Philippe Marteau13,
  16. Anne-Laure Pelletier14,
  17. Franck Carbonnel15,
  18. Philippe Seksik16,
  19. Marion Simon17,
  20. Jean-François Fléjou18,
  21. Jean-Fréderic Colombel19,
  22. Anne-Laure Charlois1,
  23. Xavier Roblin20,
  24. Stéphane Nancey1,
  25. Yoram Bouhnik4,
  26. Françoise Berger21,
  27. Bernard Flourié1
  28. and the GETAID22
  1. 1Gastroenterology Department, Lyon Sud Hospital, Pierre Bénite, France
  2. 2Gastroenterology Department, Saint-Louis Hospital, Paris, France
  3. 3Pathology Department, Beaujon Hospital, Clichy, France
  4. 4Gastroenterology Department, Beaujon Hospital, Clichy, France
  5. 5Gastroenterology Department, Bordeaux Hospital, Pessac, France
  6. 6Gastroenterology Department, INSERM U1113 and Hautepierre Hospital, Strasbourg, France
  7. 7Pathology Department, Saint-Louis Hospital, Paris, France
  8. 8Gastroenterology Department, CIC Inserm 1413, Nantes University, Nantes, France
  9. 9Pathology Department, Lariboisière Hospital, Paris, France
  10. 10Hepato-Gastroenterology Department, Robert Debre University Hospital, Reims, France
  11. 11Gastroenterology Department, Claude Huriez Hospital, Lille, France
  12. 12Gastroenterology Department, Rangueil Hospital, Toulouse, France
  13. 13Hepatology Department, Saint-Antoine Hospital, Paris, France
  14. 14Gastroenterology Department, Bichat Claude Bernard Hospital, Paris, France
  15. 15Gastroenterology Department, Bicêtre Hospital, Le Kremlin-Bicêtre, France
  16. 16Gastroenterology Department, Saint-Antoine Hospital, Paris, France
  17. 17Hepato-Gastroenterology Department, Institut Mutualiste Montsouris, Paris, France
  18. 18Pathology Department, Saint-Antoine Hospital, Paris, France
  19. 19Gastroenterology Department, Icahn School of Medicine Mount Sinai, New York, USA
  20. 20Gastroenterology Department, University Hospital, Saint Etienne, France
  21. 21Pathology Department, Lyon Sud Hospital, Pierre Bénite, France
  22. 22GETAID (Groupe d'Etudes et de Thérapeutiques des Affections Inflammatoires du tube Digestif), Lariboisière Hospital, Paris, France
  1. Correspondence to Professor Driffa Moussata, Hepato-Gastroenterology Department, Avenue de la République, Chambray-lès-Tours 37170, France; d.moussata{at}chu-tours.fr

Abstract

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.

  • IBD
  • COLORECTAL NEOPLASIA
  • ENDOSCOPIC PROCEDURES
  • COLONOSCOPY

https://doi.org/10.1136/gutjnl-2016-311892

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    Footnotes

    • 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.