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Thématique :
- MICI
Originalité :
Intermédiaire
Solidité :
Intermédiaire
Doit faire évoluer notre pratique :
Immédiatement
 
 
Nom du veilleur :
Docteur Stéphane NAHON
Coup de coeur :
 
 
Clinical Gastroenterology and Hepatology
  2016/05  
 
  2016 May;14(5):713-9  
  doi: 10.1016/j.cgh.2015.11.011  
 
  Chromoendoscopy Is More Effective Than Standard Colonoscopy in Detecting Dysplasia During Long-term Surveillance of Patients With Colitis.  
 
  I Marion JF, Waye JD, Israel Y, Present DH, Suprun M, Bodian C, Harpaz N, Chapman M, Itzkowitz S, Abreu MT, Ullman TA, McBride RB, Aisenberg J, Mayer L; Chromoendoscopy Study Group at Mount Sinai School Of Medicine.  
  http://www.ncbi.nlm.nih.gov/pubmed/?term=Chromoendoscopy+Is+More+Effective+Than+Standard+Colonoscopy+in+Detecting+Dysplasia+During+Long-term+Surveillance+of+Patients+With+Colitis.  
 
 

BACKGROUND & AIMS:

Patients with colitis have an increased risk of colorectal cancer, compared with persons without colitis. Many studies have shown chromoendoscopy (CE) to be superior to standard methods of detecting dysplasia in patients with colitis at index examination. We performed a prospective, longitudinal study to compare standard colonoscopy vs CE in detecting dysplasia in patients with inflammatory bowel diseases in a surveillance program.

METHODS:

We analyzed data from 68 patients (44 men, 24 women) diagnosed with ulcerative colitis (n = 55) or Crohn's disease (n = 13) at Mount Sinai Medical Center from September 2005 through October 2011. The patients were followed from June 2006 through October 2011 (median, 27.8 months); each patient was analyzed by random biopsy, targeted white light examination (WLE), and CE. Specimens were reviewed by a single blinded pathologist. The 3 methods were compared by using the generalized estimating equations method, and the odds ratios (ORs) for detection of dysplasia were calculated (primary outcome). Time to colectomy was analyzed by using the Cox model.

RESULTS:

In the 208 examinations conducted, 44 dysplastic lesions were identified in 24 patients; 6 were detected by random biopsy, 11 by WLE, and 27 by CE. Ten patients were referred for colectomy, and no carcinomas were found. At any time during the study period, CE (OR, 5.4; 95% confidence interval [CI], 2.9-9.9) and targeted WLE (OR, 2.3; 95% CI, 1.0-5.3) were more likely than random biopsy analysis to detect dysplasia. CE was superior to WLE (OR, 2.4; 95% CI, 1.4-4.0). Patients identified as positive for dysplasia were more likely to need colectomy (hazard ratio, 12.1; 95% CI, 3.2-46.2).

CONCLUSIONS:

In a prospective study of 68 patients with inflammatory bowel diseases, CE was superior to random biopsy or WLE analyses in detecting dysplasia in patients with colitis during an almost 28-month period. A negative result from CE examination was the best indicator of a dysplasia-free outcome, whereas a positive result was associated with earlier referral for colectomy.

 

 
Question posée
 
La chromo-endoscopie est-elle supérieure à l’endoscopie conventionnelle dans la détection de la dysplasie au cours de la rectocolite hémorragique ?
 
Question posée
 
Dans ce travail monocentrique prospectif, le taux de détection de lésions dysplasiques était augmenté par la chromoendoscopie comparativement à l’endoscopie classique à la « lumière blanche » et aux biopsies aléatoires.
 
Commentaires

Ce travail confirme l’utilité de réaliser une chromo-endoscopie afin d’augmenter la rentabilité diagnostique des biopsies au cours de la coloscopie de dépistage dans la RCH et confirme la faible rentabilité des biopsies aléatoires

 
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