Targeted Biopsies Identify Larger Proportions of Patients With Colonic Neoplasia Undergoing High-definition Colonoscopy, Dye Chromoendoscopy, or Electronic Virtual Chromoendoscopy.

It is unclear what are best and most appropriate endoscopic procedures for detecting colonic neoplasia in patients with long-term colon inflammatory bowel disease (IBD). Dye chromoendoscopy (DCE) is the standard used in IBD surveillance colonoscopies. However, studies are needed to determine the optimal endoscopic technique for detecting dysplastic lesions. We investigated current practices used in surveillance colonoscopies by IBD gastroenterologists at a single tertiary center. We also determined the rate of neoplasia detection among different surveillance endoscopic techniques in analysis of random or targeted biopsies.We collected data on 454 patients with IBD (54.5% male; mean age 50 years; mean disease duration 14.5 years; 55.9% with ulcerative colitis, 42.7% with Crohn's disease, and 1.3% with indeterminate colitis) who underwent surveillance colonoscopy from April 2011 through March 2014 at the University of Calgary, Canada. Subjects were examined using white-light standard-definition endoscopy (WLE), high-definition (HD) colonoscopy, virtual electronic chromoendoscopy (VCE), or dye chromoendoscopy (DCE); random or targeted biopsies were collected. Endoscopic and histological descriptions with suspected neoplasia were recorded. Rates of neoplasia detection by the different endoscopic procedures were compared using χ2 analysis.Of the patients analyzed, 27.7% had WLE endoscopy with random collection of biopsies, 27.3% had HD colonoscopy with random collection of biopsies, 14.1% had VCE with random collection of biopsies, 0.9% had DCE random collection of biopsies, 12.8% had HD colonoscopy with collection of targeted biopsies, 11.9% had VCE with collection of targeted biopsies, and 5.3% had DCE with collection of targeted biopsies. Neoplastic lesions were detected in 8.2% of the procedures performed in the random biopsy group (95% confidence interval, 5.6-11.7) and 19.1% of procedures in the targeted biopsy group (95% confidence interval, 13.4-26.5) (P<.001). Neoplasias were detected in similar proportions of patients by HD colonoscopy, VCE, or DCE, with targeted biopsy collection.In a large cohort of IBD patients undergoing surveillance colonoscopy, targeted biopsies identified greater proportions of subjects with neoplasia than random biopsies. Targeted collection of biopsies appears to be sufficient for detecting colonic neoplasia in patients undergoing HD colonoscopy, DCE, or VCE but not WLE.