We performed a multicenter prospective randomized controlled study to compare the diagnostic yield of dysplasia and cancer in patients undergoing long standing ulcerative colitis (UC) surveillance using high-definition white-light endoscopy with random biopsies (HDWL group) versus high-definition CE using water jet with targeted biopsies (HDCE group).Methods:
210 patients with long-standing UC (≥8 yr of extensive colitis or ≥ 10 yr of left sided ulcerative colitis) were enrolled and randomized to undergo HDWL or HDCE using indigo carmine via water-jet channel. Four mucosal biopsy specimens were taken every 10 cm between the rectum and cecum in HDWL group and targeted biopsy specimens were achieved in HDCE group. The primary endpoint was to compare the detection rates of colitis-associated dysplasia, and the secondary endpoints were to compare the detection rates of all colonic dysplasia including sporadic adenoma, colonoscopic withdrawal time, and total numbers of biopsies.Results:
HDCE group did not improve the detection of colitis-associated dysplasia, compared to HDWL group (3/102, 2.9% versus 5/108, 4.6%, P = 0.722). However, HDCE had a tendency to improve the detection of all dysplasia including colitis-associated dysplasia and sporadic adenoma, compared to HDWL (21/102, 20.6% versus 13/108, 12.0%, P = 0.093). Under using water-jet pump, the procedural time was not prolonged in HDCE group compared with HDWL group (17.8 ± 7.3 versus 18.9 ± 7.1 minute, P = 0.288). HDCE group significantly decreased the total number of biopsies, compared to HDWL group (9.2 ± 4.5 versus 33.6 ± 10.9, P < 0.001).Conclusions:
HDCE with target biopsies is not superior to detect colitis-associated dysplasic lesions to HDWL with random biopsies in patients with long standing UC. However, HDCE using water-jet pump with target biopsies has a tendency to improve the detection of all dysplastic lesions including sporadic adenoma, compared to HDWL with random biopsies without increasing procedural time.