• Driffa Moussata, Matthieu Allez, Dominique Cazals-Hatem, Xavier Treton, David Laharie, Jean-Marie Reimund, Philippe Bertheau, Arnaud Bourreille, Anne Lavergne-Slove, Hedia Brixi, Julien Branche, Jean-Marc Gornet, Carmen Stefanescu, Jacques Moreau, Philippe Marteau, Anne-Laure Pelletier, Franck Carbonnel, Philippe Seksik, Marion Simon, Jean-François Fléjou, Jean-Fréderic Colombel, Anne-Laure Charlois, Xavier Roblin, Stéphane Nancey, Yoram Bouhnik, Françoise Berger, Bernard Flourié, and the GETAID.
• Gastroenterology Department, Lyon Sud Hospital, Pierre Bénite, France.
• Gut. 2018 Apr 1; 67 (4): 616-624.

BackgroundColonoscopy with pan-chromoendoscopy (CE) is superior to standard colonoscopy in detecting neoplasia in patients with IBD. Performing random biopsies in unsuspicious mucosa after CE remains controversial.MethodsConsecutive patients with IBD who underwent surveillance colonoscopy using CE were prospectively included. The standardised procedure used CE, performed targeted biopsies or endoscopic resection on suspicious lesions and then quadrant random biopsies every 10 cm. A panel of five expert pathologists reviewed histological slides with dysplasia. Logistic regression model was used to evidence the factors associated with neoplasia in any or in random biopsies.Results1000 colonoscopes were performed in 1000 patients (495 UC, 505 Crohn's colitis). In 82 patients, neoplasia was detected from targeted biopsies or removed lesions, and among them dysplasia was detected also by random biopsies in 7 patients. Importantly, in 12 additional patients dysplasia was only detected by random biopsies. Overall, 140 neoplastic sites were found in 94 patients, 112 (80%) from targeted biopsies or removed lesions and 28 (20%) by random biopsies. The yield of neoplasia by random biopsies only was 0.2% per-biopsy (68/31 865), 1.2% per-colonoscopy (12/1000) but 12.8% per-patient with neoplasia (12/94). Dysplasia detected by random biopsies was associated with a personal history of neoplasia, a tubular appearing colon and the presence of primary sclerosing cholangitis (PSC).ConclusionsDespite their low yield, random biopsies should be performed in association with CE in patients with IBD with a personal history of neoplasia, concomitant PSC or a tubular colon during colonoscopy.Trial Registration NumberIRB 001508, Paris 7 University.Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

40 keywords...

hide…