Ulcerative Colitis Clinical Trial
Official title:
Randomized Controlled Trial of High Definition White Light Endoscopy Versus Chromoendoscopy for Dysplasia Detection in Ulcerative Colitis Surveillance
Patients with ulcerative colitis (UC) have an increased risk for colorectal cancer (CRC)
compared to the general population. Regular screening by colonoscopy is an internationally
recommended cancer prevention strategy. Random sampling of the mucosa throughout the colon
has been the mainstay of conventional surveillance practice to detect abnormalities, known as
dysplasia which can progress to CRC. This requires multiple biopsies, to be taken and
processed, a practice which is is tedious, expensive, time consuming and has a low pickup
rate. Dysplasia in UC is typically flat and patchy and can be easily overlooked with standard
conventional white light colonoscopy (WLC).
Detection can be improved by the application of dyes which highlight more subtle
abnormalities. This practice, known as chromoendoscopy (CE) is better than WLC at dysplasia
detection but more time consuming for the patient and cannot guarantee that the whole colon
is covered. CE has only been compared in clinical trials with standard definition endoscopy
rather than the recently available high definition endoscopes with better resolution and
picture. High definition (HD) endoscopy uses a high definition onitor and a high resolution
CCD (charge coupled device) providing much better images than standard video endoscopy. HD
colonoscopy promises therefore to provide an alternative to CE in UC surveillance without the
need for the extra time and experience required for dye spraying for both endoscopists and
nursing staff.
The investigators plan to do a randomized trial to assess HD colonoscopy alone compared to
chromoendoscopy (with HD colonoscopies) for dysplasia detection during surveillance for
ulcerative colitis. There have been no trials comparing these two modalities and the
investigators hope to provide evidence that the additional benefit of CE over HD colonoscopy
would be marginal and therefore CE would be reserved for procedures using standard definition
scopes.
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