Incremental Detection Rate of Dysplasia and Sessile Serrated Polyps/Adenomas Using Narrow-Band Imaging and Dye Spray Chromoendoscopy in Addition to High-Definition Endoscopy in Patients with Long-Standing Extensive Ulcerative Colitis: Segmental Tandem Endoscopic Study

Abstract

High-definition (HD) endoscopy is recommended in surveillance colonoscopy for detecting dysplasia in patients with ulcerative colitis (UC). Dye-spray chromoendoscopy (DCE) and narrow-band imaging (NBI) are often used as adjunctive techniques of white-light endoscopy (WLE) in real-world practice. However, the incremental detection ability of DCE and NBI added to HD-WLE for dysplasia and serrated lesions has not yet been evaluated using tandem endoscopy in patients with long-standing extensive UC. We enrolled patients with extensive UC for >8 years who were in clinical remission (partial Mayo score < 2) at the Samsung Medical Center in Seoul, Republic of Korea. HD-WLE was performed first. Subsequently, HD-NBI and HD-DCE with indigo carmine were performed using the segmental tandem colonoscopy technique. A total of 40 patients were eligible, and data obtained from 33 patients were analyzed. The incremental detection rates (IDRs) for dysplasia and serrated lesions were calculated. HD-WLE detected three dysplasia and five sessile serrated adenomas/polyps (SSAs/Ps). HD-NBI and HD-DCE did not detect additional dysplasia (IDR = 0%; 95% confidence interval (CI): 0–56.2%). HD-NBI identified one missed SSA/P (IDR = 7.7%; 95% CI: 1.4–33.3%), and HD-DCE detected seven missed SSAs/Ps (IDR = 53.9%; 95% CI: 29.1–76.8%). Logistic regression found that HD-DCE increased the detection of SSAs/Ps compared to HD-WLE and/or HD-NBI (odds ratio (OR) = 3.16, 95% CI: 0.83–11.92, p = 0.08). DCE in addition to HD-WLE improved the detection of SSAs/Ps, but not dysplasia, in patients with long-standing extensive UC.