Estudio comparativo de diversos métodos de detección de lesiones neoplásicas y pre-neoplásicas en pacientes con enfermedad inflamatoria intestinal a quienes se realiza una colonoscopia de cribado de cáncer colorrectal

Abstract

Introduction: The risk of colon cancer is greater in patients with inflammatory bowel disease (IBD) than in the general population. Chromoendoscopy with dye (DCE) is the currently recommended method for detecting dysplasia in screening colonoscopies in IBD patients; however, the role of virtual chromoendoscopy (VCE) is not yet well defined. Objective: The object of this study was to compare DCE and VCE with the iSCAN 1 system in the detection of neoplastic lesions in patients with IBD and to compare this lesions detection rate with the detection rate of an historical cohort using random biopsies as a screening method. Design: We conducted a prospective, single-center, randomized study in patients with IBD who underwent a colonoscopy for colon cancer screening. A total of 129 patients were included in the prospective period between March 2018 and June 2019, and were randomized to undergo a DCE (n = 67) or a VCE (n = 62). The rates of detection of neoplastic lesions by the 2 endoscopic techniques were compared. In the retrospective period 260 patients were included, who underwent a colonoscopy for colon cancer screening between June 2007 and December 2011, and neoplastic lesions detected using random biopsies were analyzed. Results: In prospective period, a total of 19 (14,7%) neoplastic lesions (9 adenomas and 10 low-grade dysplasias (LGD)) was detected in 129 patients, 12 lesions in the DCE group (17.9%), and 7 lesions in the VCE group (11,3%; p=0.2); no differences were found in the overall rate of detection of lesions (neoplastic or nonneoplastic; p=1). The median of the total examination time and endoscope withdrawal time (minutes) was significantly lower in the VCE group than in the DCE group (15 vs 20 and 10 vs 14, respectively; p<0.001). In retrospective period, a total of 19 neoplastic lesions (11 adenomas and 8 LGD) in 260 patients, which is a lower detection rate than in prospective period (7,3% vs 14,7%; p=0,02). Conclusions: No differences occurred in the rate of detection of neoplastic lesions between DCE and VCE with iSCAN 1. The time spent on the technique with VCE is significantly less than that with DCE. The chromoendoscopy (both, DCE and VCE) detect more neoplastic lesions than random biopsies in screening colonoscopies in patients with IBD.