Which method is more useful for detecting ulcerative colitis severity? Standard white light or narrow band imaging endoscopy?

Öz

Background and Aims: In this study, we aimed to show the differences in determining endoscopic severity in ulcerative colitis between standard white light endoscopy and narrow band imaging by comparing results with the histopathological examination. Materials and Methods: A total of 30 (16 female, 14 male) ulcerative colitis subjects were recruited prospectively. Colonoscopy and biopsy were applied in all subjects. Results: Narrow band imaging was more sensitive than standard white light endoscopy in distinguishing normal endoscopic findings (p=0.0015). Evaluation of the disappearance of vascular pattern was more sensitive with narrow band imaging than with standard white endoscopy (p=0.04). The patients evaluated as normal with standard endoscopy but as not normal with histopathological diagnosis had histopathologically mild to moderate inflammation. Mild to moderate inflammation was more prevalent in histopathological findings than in standard white endoscopy (p=0.015). Conclusions: Narrow band imaging was more sensitive for evaluating the disappearance of vascular pattern than standard endoscopy evaluation in patients with low disease activity. We think this is a precursor study for multi-center studies regarding detection of malignancy in ulcerative colitis with long-term disease.

Anahtar Kelimeler

• Ulcerative colitis, standard white light endoscopy, narrowband imaging endoscopy

Ülseratif kolit olgularında standart konvansiyonel endoskopi mi, dar bant yöntemi ile yapılan endoskopi mi şiddet belirlemede etkindir?

Öz

Amaç: Bu çalışmada amacımız ülseratif kolit olgularında endoskopik değerlendirmede, standart yöntem ve dar bant görüntüleme arasında fark olup olmadığı ve her iki tekniğin histopatolojik bulgular ile karşılaştırılmasıdır. Gereç ve Yöntem: Çalışmaya ülseratif kolit tanısıyla takip ve tedavi edilen ve kolonoskopi uygulanan 30 hasta (16 kadın, 14 erkek) prospektif olarak dahil edilmiştir. Tüm olgulara kolonoskopi uygulanmış ve biyopsi alınmıştır. Bulgular: Dar bant görüntülemede standart endoskopiye göre normal endoskopik bulgunun anlamlı olarak daha az görüldüğü bulunmuştur (p=0.015). Vasküler paternin kaybolması dar bant görüntülemede standart endoskopiye göre daha anlamlı olarak değerlendirildiği görülmüştür (p=0.04). Standart endoskopide normal olarak değerlendirilen fakat histopatolojik olarak normal çıkmayan tüm vakalarda histopatolojik olarak hafif ve orta şiddette inflamasyon tespit edilmiştir. Hafif-orta şiddette inflamasyon ise histopatolojik olarak standart endoskopiye oranla anlamlı olarak yüksek çıkmıştır (p=0.015). Sonuç: Ülseratif kolit olgularında özellikle düşük hastalık aktivitesi olan hastaların endoskopik değerlendirmesinde dar bant görüntüleme tekniği standart konvansiyonel endoskopiye göre daha değerli olmasına rağmen dar bant görüntüleme yöntemi ile erken malignite tespitinde çok merkezli ve daha uzun süreli hastalığa (10 yıl ve üzeri) sahip olan hastalar ile değerlendirme yapılmasının uygun olacağı kanaatindeyiz.

Anahtar Kelimeler

• Ülseratif kolit, standart endoskopi, dar bant yöntemli endoskopi

Kaynakça

1. Stange EF, Travis SPL, Vermeire S, et al. for the The European Crohn’s and colitis organisation (ECCO). European evidence-based consensus on the diagnosis and management of ulcerative colitis: Definitions and diagnosis. J Crohns Colitis 2008;2:1-23.
2. Nak SG. Clinical features of ulcerative colitis, natural course and complications. Turkiye Klinikleri J Gastroenterohepatol - Special Topics 2009;2:13-21.
3. DOLAR ME. Diagnosis and differantial diagnosis of ulcerative colitis Turkiye Klinikleri J Gastroenterohepatol - Special Topics 2009;2:22-29.
4. Chinyu SU, Lichtenstein GR. Ulcerative colitis. In: Sleisenger & Fordtran’s. Feldman M, Friedman LS, Brandt LJ. Eds. Gastrointestinal and liver disease. 8th ed. Saunders Elsevier 2006;2499-549.
5. Biancone L, Michetti P, Travis S, et al. for the European Crohn’s and colitis organisation (ECCO) European evidence-based consensus on the management of ulcerative colitis: Special situations. J Crohns Colitis 2008;2:63-92.
6. Van Den Broek FJC, Fockens P, Dekker E. Review article: new developments in colonic imaging. Aliment Pharmacol Ther 2007;26 Suppl 2:91-9.
7. Reiser JR, Waye JD, Janowitz HD, Harpaz N. Adenocarcinoma in strictures of ulcerative colitis without antecedent dysplasia by colonoscopy. Am J Gastroenterol 1994;89:119-22.
8. Hurlstone DP, Sanders DS, Lobo AJ, et al. Indigo carmine-assisted high-magnification chromoscopic colonoscopy for the detection and characterisation of intraepithelial neoplasia in ulcerative colitis: a prospective evaluation. Endoscopy 2005;37:1186-92.

9. Matsumoto T, Kudo T, Jo Y, et al. Maginifying colonoscopy with narrow band imaging system fort he diagnosis of dysplasia in ulcerative colitis: a pilot study. Gastrointest Endosc 2007; 66:957-65.
10. Rutter MD, Saunders BP, Wilkinson KH, et al. Most dysplasia in ulcerative colitis is visible at colonoscopy. Gastrointest Endosc 2004; 60:334-9.
11. Kaday›fç› A. Gastrointestinal Endoskopi: Dün, Bugün, Yar›n. Güncel Gastroenteroloji 2007;11:123-7.
12. Osterman MT, Lichtenstein GR. Ulcerative colitis. In: Sleisenger & Fordtran's Mark Feldman MD, Lawrence S, Friedman MD, Lawrence J, Brandt MD, Eds. Gastrointestinal and Liver Disease. 9th ed. Philadelphia. Saunders 2010;1975-2016.
13. Modigliani R Endoscopic management of inflammatory bowel disease. Am J Gastroenterol 1994;89(8 Suppl):S53-65.
14. Baars JE, Nuij VJ, Oldenburg B, et al. Majority of patients with inflammatory bowel disease in clinical remission have mucosal inflammation. Inflamm Bowel Dis 2011 Nov 8. doi: 10.1002/ibd.21925. [Epub ahead of print]
15. Göral V. Endoscopic fFeatures of ulcerative colitis Turkiye Klinikleri J Gastroenterohepatol-Special Topics 2009;2:34-40.
16. Van den Broek FJ, Fockens P, Van Eeden S, et al. Endoscopic trimodal imaging for surveillance in ulcerative colitis: randomised comparison of high-resolution endoscopy and autofluorescence imaging for neoplasia detection; and evaluation of narrow-band imaging for classification of lesions. Gut 2008;57:1083-9.
17. Kudo T, Matsumoto T, Esaki M, et al. Mucosal vascular pattern in ulcerative colitis: observations using narrow band imaging colonoscopy with special reference to histologic inflammation. Int J Colorectal Dis 2009;24:495-501.