The SCENIC international consensus published in 2015 established chromoendoscopy combined with high definition white light endoscopy as the preferred method for colorectal cancer surveillance in patients with inflammatory bowel disease. However, most studies evaluating its efficacy have been conducted at academic medical centers. Limited data is available from community settings where most such surveillance is performed.Methods:
All patients with inflammatory bowel disease referred to a single interventional endoscopist at a 580-bed community teaching hospital between July 2015- August 2016 (14 mo) for colorectal cancer surveillance underwent chromoendoscopy with high definition white light endoscopy. Olympus 190 series adult or pediatric colonoscopes were used in all patients. A solution of 10 mL of 0.8% indigo carmine in 250 mL of normal saline was used for chromoendoscopy. No random biopsies were obtained. Patients were educated about the new guidelines before the procedure and informed consent was obtained. Polypectomy and endoscopic resection were performed during the same session where needed.Results:
A total of 23 procedures were performed in 22 patients. Male: female ratio was 1:1. Mean age was 58 years (range 29–81). Underlying disease was ulcerative colitis in 15, Crohn disease in 5, and indeterminate colitis in 2. Mean disease duration at time of procedure was 204 months (range 24–528). Adult colonoscope was used in 12 procedures and pediatric colonoscope in 11. Mean total procedure duration was 41 minutes (range 26–84). Mean cecal intubation time was 11 minutes (range 5–22). Mean withdrawal time was 31 minutes (range 16–75). Conscious sedation was used in all patients. Polyps were found in 17/23 (74%) procedures, of which 14 (61%) had adenomatous polyps. A total of 51 polyps were removed of which 34 were clinically significant lesions (18 tubular adenomas; 7 serrated adenomas; 9 large hyperplastic polyps). Endoscopic mucosal resection was done for a total of 3 polyps in 2 patients (2 tubular adenomas; one serrated adenoma).Conclusions:
Chromoendoscopy with high definition white light endoscopy has a high dysplasia detection rate in patients with IBD undergoing colon cancer surveillance. However, longer procedure durations and lack of specific reimbursement codes may deter its widespread use in community practices.