DISPLASIA E CANCRO IN PAZIENTI CON RETTOCOLITE ULCEROSA DI LUNGA DURATA: COLONSCOPIA TRADIZIONALE VS PANCROMOENDOSCOPIA VS FUJINON INTELLIGENT COLOUR ENHANCEMENT (FICE). STUDIO PROSPETTICO RANDOMIZZATO.

Background Patients with long standing ulcerative colitis have increased risk of colorectal cancer. Current screening endoscopy protocols based on white light endoscopy (WLE) and random biopsies are laborious and of uncertain sensitivity. Novel endoscopic techniques include chromoendoscopy ( CE) and virtal chromoendocopy (FICE) with targeted biopsies. Aim The aim was to compare WLE with random biopsies , CE and FICE with targeted biopsies for the detection of suspicious lesions and dysplasia during surveillance colonoscopy in long standing ulcerative colitis patients. Methods In this study 158 patients were prospectively randomized and examinated by WLE with random biopsies ( n 78 ), by CE (n 41) and by FICE (n 39) with targeted biopsies. We compared the number of suspicious lesions detected per patient in every group and histopathology of all detected lesions was confirmed by evaluation of biopsy specimens. Results In the WLE group we detected suspicious lesions in 17 patients ( 22%), in 30 patients (73%) in the CE group and in 21 patients(54%) in FICE group (p<0,0001). More suspicious mucosal areas per patient was detected by CE and FICE (51 and 28 %) vs WLE (4%); no significative difference was observed in detection of DALM/polyps or neoplasia ( 1 patient in WLE group). Histopathology evaluation of biopsy specimens detected dysplasia o neoplasia in 11 patients of WLE group (14%), in 10 patients of CE group (24%), in 7 patients in FICE group (18%), with no significant difference in the 3 groups but comparable with WLE with fewer biopsies. Conclusions The use of CE and FICE improved significantly the number of suspicious lesions detected during surveillance colonoscopy in long standing ulcerative colitis patients, almost for suspicious mucosal areas. The detection of dysplasia with CE and FICE was comparable to WLE with fewer biopsies taken.