P100 Higher yield of serrated and adenomatous dysplasia detected with chromoendoscopy when compared with high-definition in patients with Primary Sclerosing Cholangitis and Inflammatory colitis.
Gupta, V.(1);Hartery, K.(2);Oxford IBD Cohort Investigators, I.(2);Bassett, P.(2);Culver, E.(2);East, J.(2);
(1)Consultant, Department Of Gastroenterology- University Hospital Of Wales, Cardiff, United Kingdom;(2)Oxford University Hospitals, Translational Gastroenterology Unit, Oxford, United Kingdom Oxford IBD Cohort investigators
Background
There is an increased risk of colorectal dysplasia/cancer in patients with primary sclerosing cholangitis and inflammatory bowel disease (PSC-IBD); cumulative risk of 14% at 5 years and 17% at 10 years. SCENIC (2015) consensus guidelines recommend surveillance with chromoendoscopy (CE) and use of a high definition (HD) scope with white light colonoscopy. We aimed to assess the value of CE and HD scope in detection of dysplasia in PSC-IBD.
Methods
We analysed all colonoscopic surveillance performed for PSC-IBD between 2010-2020 at Oxford University Hospitals (n=422 procedures). Continuous variables were assessed by Kruskal-Wallis (three groups) and categorical variables by Chi-square test. Repeat measurements were accounted for by multilevel regression models with individual colonoscopies nested within patients. Multilevel ordinal logistic regression was used for assessment of bowel prep. Outcomes were adjusted for confounding variables (adj).
Results
359 colonoscopies were analysed in 91 patients with PSC-IBD (69/422 were excluded as prior dysplasia detected). CE and HD scope use increased in frequency over the 10-year period (p=0.02). HD were rarely used in those with bowel preparation deemed inadequate (p<0.001), but there was no association between CE and bowel prep quality. Dysplasia detection (adenomatous and serrated lesions) was higher with CE compared with white light examination; 14% vs 3% (p<0.001), and after adjusting for confounders (p<0.009) and use of HD scope (p<0.01), OR 5.02 (CI 1.43-17.7). Dysplasia detection was higher with HD compared with standard definition (SD); 14% vs 6% (p<0.04), but was non-significant after adjusting for confounders, OR 1.93 (CI 0.69-5.4). Dysplasia was more likely to be found on targeted than random colonic biopsies (p<0.001).
CE increased detection of serrated lesions (9% vs 2% (p=0.06) OR 3.5 adj) and more so adenomatous dysplasia (6% vs 1% (p=0.03) OR 12 adj) compared to white light. HD increased detection of serrated lesions (9% vs 3.5% (p=0.04) OR 2 adj) but not adenomatous dysplasia (6% vs 2.5% (p=0.19) compared to SD. (Table 1)
Conclusion
CE is superior to HD and SD white light examination for dysplasia detection in PSC-IBD after accounting for confounders and performed better for adenomatous than serrated lesions.