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Jason Reich, Nisha Varadarajan, Pia Prakash, Marie Borum, P-84 High Definition Technology can Enhance Adenoma Detection in Inflammatory Bowel Disease Patients, Inflammatory Bowel Diseases, Volume 18, Issue suppl_1, 1 December 2012, Page S50, https://doi.org/10.1097/00054725-201212001-00117
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Patients with inflammatory bowel disease (IBD) have increased risk for the development of colorectal carcinoma. In previous studies, 3.6% of patients were reported to have adenomas detected on surveillance colonoscopies. It has also been reported that high definition (HD) colonoscopes have improved targeted detection of dysplastic lesions in IBD. This study evaluated the detection of colitis-associated dysplasia and adenomas using HD colonoscopes.
Medical records of consecutive patients seen in an IBD program at a university gastroenterology practice were evaluated. Patient age, gender, race, disease type (UC, CD), date of diagnostic colonoscopy and subsequent surveillance colonoscopies were obtained. Colitis-associated dysplasia and adenomas detected prior to and following the initiation of HD technology were documented. Patients were excluded if they were lost to follow-up, underwent total colectomy with ileostomy and those transferring care to the practice without previous medical records. A database, maintaining patient confidentiality, was created using Microsoft Excel. Statistical analysis was performed using Fisher Exact test and t-test with significance set at P < 0.05.
Medical records of 303 patients (179 females, 124 males) with IBD (130 UC, 173 CD) were evaluated. There were 170 white, 80 African-American and 53 of other or undocumented ethnicity. The mean age was 40 years. 31 patients (10%) had adenomas (23 UC, 8 CD). There was a significant difference (P = 0.004) in the rate of which adenomas were detected in patients with UC compared to CD. Additionally, there was a significant difference (P = 0.0001) in the rate at which adenomas were detected prior to HD technology (5.2%) and following HD technology (15.2%). There was no significant difference in the prevalence of adenomas based upon gender (P = 0.18), race (P = 0.84), or age (P = 0.29). Five (1.6%) patients had colitis-associated dysplasia (2UC, 3CD). 0 patients had dysplasia detected prior to HD technology and 5 patients were identified to have dysplasia detected following the introduction of HD technology (P = 0.06). There was no significant difference in prevalence of colitis-associated dysplasia based upon gender (P = 0.164), race (P = 0.39), age (P = 0.78) or disease type (P = 1.000)
High definition colonoscopes have been reported to increase detection of dysplastic lesions in patients with IBD. While the sample size was too small to analyze the impact of HD on colitis-associated dysplasia, the detection of dysplasia following introduction of HD colonoscopes approached significance. However, this investigation revealed that there was a significant increase in the detection of adenomas in IBD patients using HD technology. While other potential factors, (i.e. pre-procedure cleansing, disease severity and skill of the endoscopist) can influence adenoma detection, recognition of the potential impact of HD technology is important. Physicians should utilize HD technology as much as possible when evaluating IBD patients to ensure optimum care.
