Ulcerative Colitis Clinical Trial
Official title:
Randomised,Controlled Trial of Narrow Band Imaging With Magnification (NBI) Versus White Light Endoscopy for Dysplasia Detection in Ulcerative Colitis Surveillance
The purpose of the study is to determine whether a new colonoscopic viewing technique called narrow band imaging (NBI) helps doctors detect more patients with at leat one pre-cancerous area (dysplasia associated lession or mass, MALMs) than conventional colonoscopy using white light alone.
Colorectal cancer is the second commonest cause of cancer death. Patients with colitis have
a substantially increased risk of death from colorectal cancer which increases with lenght
of time the patient has had colitis. This can be as high as a 30% chance of colorectal
cancer after 30 years of colitis. Colonoscopic surveillance of colitis patients has been
shown to reduce the risk of colorectal cancer and allow detection at an earlier stage, but
even with meticulous examination, some precancerous lesions or cancers are missed.
Precancerous lesions in colitis are difficult to see and endoscopist have used spraying dye
on the lining of the bowel (chromoendoscopy) successfully to improve detection of abnormal
areas: however this is time consuming and requires extra time and equipment and despite the
benefits seen in multiple studies is not widely used in routine clinical practice in the UK.
Narrow band imaging (NBI) is a technique that relies on light filters to improve contrast
for the smallest blood vessels in the bowel lining which shows up precancerous areas as they
have a richer vascular network. It is sometimes described as "digital chromoendoscopy" as
the images produced are similar to chromoendoscopy, but it is much simpler and quicker to
use. With magnification it allows assessment of the fine mucosal surface pattern (pit
pattern) of lesion which allows and assessment of their likelihood of being precancerous.
Autofluorescence endoscopy uses short wavelength light and light filters to produce a false
colour image of the bowel lining where polyps stand out. These techniques have been used
with some success in the oesophagus and stomach but little work is available for the colon.
We aim to see if NBI with magnification is better that standard colonoscopy for detecting
precancerous areas. This is likely as it produces images similar to chromoendoscopy which is
already shown to help. If a potentially precancerous area is found we will use other types
of endoscopy, particularly NBI autofluorescence to see if these techniques are helpful for
discriminating between pre-cancerous and non pre-cancerous areas
;
Allocation: Randomized, Intervention Model: Parallel Assignment, Masking: Open Label, Primary Purpose: Diagnostic
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