PTH-030 Conventional versus virtual chromoendoscopy for colitis surveillance: dysplasia detection, feasibility and patient acceptability (convince)

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Abstract

Introduction

Chromoendoscopy (CE) is the recommended surveillance technique for dysplasia in colitis, but uptake has been limited. Virtual CE (VCE) by Fujinon Intelligent Colour Enhancement digitally reconstructs mucosal images in real-time, without the technical challenges of CE. The literature provides limited information on patient experience (PE); imperative to adherence to surveillance programmes. We performed a multi-faceted randomised crossover trial to evaluate acceptability of study design and obtain preliminary comparative procedural performance data and PE using CE vs VCE.

Methods

Patients 18–75 y due surveillance colonoscopy were randomised to undergo CE or VCE first. After 3–8 weeks, participants underwent colonoscopy with the second technique, performed by an endoscopist blinded to the results of the first. Patient recruitment/retention, missed dysplasia by VCE/CE, endoscopist’s prediction of dysplasia and contamination (endoscopists memory/sampling of the 1 st procedure) were recorded. PE was assessed by validated questionnaires. This abstract presents independent research funded by the NIHR under its Research for Patient Benefit Programme (PB-PG-0614–34040). The views expressed are those of the authors and not necessarily those of the NHS, the NIHR or the Department of Health.

Results

60 patients were recruited (recruitment rate 80%) over an 11 month period. 48 patients completed the trial (retention rate 80%); 23 (11F, 48.4±14.6 y) received VCE and 25 (9 F,41.4±12.3 y) CE first. Examination time for CE vs VCE was 20±7 vs 14±4 mins respectively (p<0.001; CI 3.5–8). There were no episodes of contamination. 11 dysplastic lesions were detected in 7/48 (14.5%). Per-lesion analysis: VCE missed 1 lesion (miss rate 9.1%), CE missed 2 lesions in 2 patients (miss rate 18.2%). Per-patient analysis: miss rate for dysplasia using VCE was 1/48 (2.1%) VCE and CE 2/48 (4.2%). Diagnostic accuracy for dysplasia using VCE 93.94% (85.2–98.32) vs CE 76.9% (66.9%–98.2%). Visual analogue scale for pain experienced using VCE and CE were 27.4±17.5 mm and 34.7±18 mm respectively. Patient preference for VCE was 67% (n=31) vs CE 33% (n=15) in n=46, p<0.001.

Conclusions

This is the first study to incorporate PE in a colitis surveillance trial and has demonstrated feasibility of the trial design itself. VCE is safe, appears technically less challenging, quicker and more comfortable procedure for patients with dysplasia detection at least as good as CE, thus overcoming many of barriers to the wider adoption of CE. This trial forms the successful foundation to inform a multicenter trial to confirm the value of VCE for colitis surveillance.

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