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Effect of chromoendoscopy in the proximal colon on colorectal neoplasia detection in Lynch syndrome: a multicenter randomized controlled trial.
- Source :
-
Gastrointestinal endoscopy [Gastrointest Endosc] 2019 Oct; Vol. 90 (4), pp. 624-632. Date of Electronic Publication: 2019 Apr 24. - Publication Year :
- 2019
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Abstract
- Background and Aims: Patients with Lynch syndrome (LS) undergo regular surveillance by colonoscopy because of an increased risk of colorectal neoplasia, particularly in the proximal colon. Chromoendoscopy (CE) has been reported to improve neoplasia detection compared with conventional white-light endoscopy (WLE), but evidence is limited. Our aim was to investigate the effect of CE in the proximal colon on detection of neoplastic lesions during surveillance in LS.<br />Methods: This was a multicenter prospective randomized controlled trial of 246 patients with LS who were randomly assigned (1:1) to conventional WLE (n = 123) or colonoscopy with CE in the proximal colon (n = 123), stratified for previous colorectal adenomas and enrolling center. Two years after baseline colonoscopy, patients underwent colonoscopy with CE in the proximal colon. The primary outcome was the proportion of patients with at least one neoplastic lesion at baseline and after 2 years.<br />Results: Neoplasia detection rates at baseline colonoscopy were 27% for WLE versus 30% for CE (odds ratio [OR], 1.23; 95% confidence interval [CI], 0.69-2.2; P = .56). In the proximal colon, neoplasia detection rates were 16% for WLE versus 24% for CE (OR, 1.6; 95% CI, 0.9-3.1; P = .13). Total procedure time was 9 minutes longer in the CE group. At follow-up after 2 years, neoplasia detection rates were similar in both groups: 26% for the original WLE group versus 28% for the CE group (OR, 1.1; P = .81).<br />Conclusions: CE in the proximal colon for LS surveillance was not superior to WLE with respect to the initial detection of neoplasia, and not associated with reduced neoplasia detection rates after 2 years. The value of CE remains to be established. (Clinical trial registration number: NCT00905710.).<br /> (Copyright © 2019 American Society for Gastrointestinal Endoscopy. Published by Elsevier Inc. All rights reserved.)
- Subjects :
- Adenocarcinoma pathology
Adenoma pathology
Adult
Colorectal Neoplasms pathology
Colorectal Neoplasms, Hereditary Nonpolyposis pathology
Coloring Agents
Female
Humans
Indigo Carmine
Male
Middle Aged
Netherlands
Watchful Waiting
Adenocarcinoma diagnosis
Adenoma diagnosis
Colonoscopy methods
Colorectal Neoplasms diagnosis
Colorectal Neoplasms, Hereditary Nonpolyposis diagnosis
Subjects
Details
- Language :
- English
- ISSN :
- 1097-6779
- Volume :
- 90
- Issue :
- 4
- Database :
- MEDLINE
- Journal :
- Gastrointestinal endoscopy
- Publication Type :
- Academic Journal
- Accession number :
- 31028782
- Full Text :
- https://doi.org/10.1016/j.gie.2019.04.227