Virtual chromoendoscopy with iSCAN as an alternative method to dye-spray chromoendoscopy for dysplasia detection in long-standing colonic inflammatory bowel disease: a case-control study.

OBJECTIVE: Patients with long-standing colonic inflammatory bowel disease (cIBD) are at increased risk of developing colorectal cancer (CRC). Dye-spray chromoendoscopy (DCE) with targeted biopsies is the preferred technique for surveillance of dysplasia. Virtual chromoendoscopy (VCE) are arising to improve detection rates and adherence to surveillance guidelines, although its role is not yet well defined. The purpose of this study is to assess the effectiveness of VCE with iSCAN as an alternative method for dysplasia detection in cIBD. METHODS: Retrospective case-control study with 191 patients included, 98 in the DCE (Indigo carmine) group and 93 in the VCE (iSCAN, twin-mode 1-3) group. The dysplasia detection and the exploration time were analysed. A logistic regression analysis was performed to ascertain the factors related to colonic dysplasia. RESULTS: A total of 44 dysplastic lesions were detected in 21 (11%) patients. No differences were found in the per lesion and the per patient analysis (dysplastic versus non-dysplastic). Median withdrawal time was shorter in the VCE group than in the DCE group (9 min versus 14 min; p < .001). Location of lesions in the right colon was independently associated with an increased risk for colonic dysplasia (OR = 4.04, 95%CI 1.11-14.65; p = .034) after adjusting for age at inclusion, age at diagnosis, high risk for CRC and Kudo pit pattern. CONCLUSIONS: VCE with iSCAN presents a similar diagnostic performance to conventional DCE in the detection of colonic dysplasia in patients with long-standing cIBD. Furthermore, VCE with iSCAN is a less time-consuming surveillance alternative to DCE.

Crohn's disease and color Doppler sonography: response to treatment and its relationship with long-term prognosis.

PURPOSE: To evaluate the ability of sonography to detect changes in patients undergoing treatment for Crohn's disease and whether these findings are related to the patient's long-term outcome. METHODS: Twenty-eight patients with Crohn's disease were examined prospectively using gray-scale and color Doppler sonography before and during treatment. Three sonographic examinations were made: on the first day of treatment, between 3 and 8 days later, and approximately 4 weeks after starting the treatment. Sonographic examination included an evaluation of maximum bowel wall thickness and vascularity pattern. The sonographic data were compared with clinical and laboratory data, and possible relation with the patient's long-term outcome was considered. RESULTS: Initial baseline sonograms revealed at least 1 thickened segment of the bowel wall in all of the patients. In this initial examination, 18 of 22 patients (81%) with clinically active disease had moderate or marked parietal vascularity. A statistically significant reduction in the vascularity of the affected bowel was observed on the third sonographic examination (p < 0.05). Seventeen patients who were in clinical remission had relapses and were treated with immunosuppressive therapy or surgery during the follow-up. Eighty-six percent of the patients with residual hyperemia on sonographic examination after treatment had an unfavorable clinical course compared with only 30% of the patients with no, or barely visible, residual hyperemia (p < 0.01). CONCLUSION: Sonography can identify bowel inflammation and its changes during treatment. In patients with Crohn's disease, hyperemia on color Doppler sonography during clinical remission after treatment may reflect an increased risk of relapse.