SNFGE SNFGE
 
Thématique :
- MICI
Originalité :
Très original
Solidité :
Très solide
Doit faire évoluer notre pratique :
Dans certains cas
 
 
Nom du veilleur :
Professeur Philippe SEKSIK
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.  
 
  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.  
  https://www.ncbi.nlm.nih.gov/pubmed/26656297  
 
 

Abstract

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 chromoendoscopie permet-elle de mieux détecter les dysplasie aux cours des MICI ?
 
Question posée
 
Oui.
 
Commentaires

C’est un commentaire dans Gastroenterology de février 2017:
Is Chromoendoscopy Superior to Standard Colonoscopy for Long-term Surveillance of Patients With Inflammatory Bowel Disease? Haleh Vaziri, Joseph C. Anderson qui nous alerte et vient compléter un article paru dans CHG. En effet, cet article donne l’évolution à long terme (en médiane 27,3 mois) d’un essai au cours duquel un même patient avait une endoscopie standard avec biopsies systématiques et ciblées suivie d’une chromo-endoscopie (CE) à la recherche de dysplaise. L’étude princeps avait paru en 2008 (Am J Gastroenterol 2008;103:2342–2349). Huit ans plus tard les auteurs reviennent avec les données longitudinales de 68 des 102 patients initiaux et montrent que la CE est supérieure à l’endoscopie standard pour détecter une dysplasie chez les patients ayant une MICI colique. Même si des limites méthodologiques sont relevées, comme par exemple l’absence d’endoscopes haute définition, l’absence de contrôle qualité, l’absence de prise en compte du temps d’examen etc…, ce papier devrait contribuer à changer nos pratiques.

 
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