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Multicentre randomised controlled trial on virtual chromoendoscopy in the detection of neoplasia during colitis surveillance high-definition colonoscopy (the VIRTUOSO trial)

Multicentre randomised controlled trial on virtual chromoendoscopy in the detection of neoplasia during colitis surveillance high-definition colonoscopy (the VIRTUOSO trial)
Multicentre randomised controlled trial on virtual chromoendoscopy in the detection of neoplasia during colitis surveillance high-definition colonoscopy (the VIRTUOSO trial)

Background Longstanding colonic IBD increases the risk of developing colorectal cancer. The utility of chromoendoscopy with standard-definition white light technology has been established. However, the use of high-definition virtual chromoendoscopy (HDV) in colitis surveillance remains undefined. Objective To compare the performance of HDV (i-scan OE mode 2) with high-definition white light (HDWL) for detection of neoplasia in patients with IBD undergoing surveillance colonoscopy. Additionally, we assessed the utility of protocol-guided quadrantic non-targeted biopsies. Design A multioperator randomised controlled trial was carried out in two centres in the UK. Total of 188 patients (101 men, mean age 54) with longstanding ulcerative or Crohn’s colitis were randomised, prior to starting the surveillance colonoscopy, to using either HDV (n=94) or HDWL (n=94) on withdrawal. Targeted and quadrantic non-targeted biopsies were taken in both arms per-randomisation protocol. The primary outcome was the difference in neoplasia detection rate (NDR) between HDV and HDWL. Results There was no significant difference between HDWL and HDV for neoplasia detection. The NDR was not significantly different for HDWL (24.2%) and HDV (14.9%) (p=0.14). All intraepithelial neoplasia (IEN) detected contained low-grade dysplasia only. A total of 6751 non-targeted biopsies detected one IEN only. The withdrawal time was similar in both arms of the study; median of 24 min (HDWL) versus 25.5 min (HDV). Conclusion HDV and HDWL did not differ significantly in the detection of neoplasia. Almost all neoplasia were detected on targeted biopsy or resection. Quadrantic non-targeted biopsies have negligible additional gain. Trial registration number Clinical Trial.gov ID NCT02822352.

0017-5749
Kandiah, Kesavan
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Subramaniam, Sharmila
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Thayalasekaran, Sreedhari
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Chedgy, Fergus Jq
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Longcroft-wheaton, Gaius
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Fogg, Carole
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Brown, James F
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Smith, Samuel Cl
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Iacucci, Marietta
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Bhandari, Pradeep
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Kandiah, Kesavan
89a679c5-2e96-4ea9-8d4c-b03e35fff94e
Subramaniam, Sharmila
4994d15f-b6cb-4ff5-ae83-ddf429807bfa
Thayalasekaran, Sreedhari
faeaf07c-7303-46ae-a400-c06754712695
Chedgy, Fergus Jq
5da28c15-d5ae-426f-b3ce-7e8769f8913a
Longcroft-wheaton, Gaius
64dd8c07-1e26-4b7d-8806-9e84495b39aa
Fogg, Carole
42057537-d443-462a-8944-c804252c973b
Brown, James F
9d3abf07-c43e-4a01-a3bc-4dfe26b26101
Smith, Samuel Cl
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Iacucci, Marietta
cff6584c-e38d-4d4b-81bb-375c24cf60e3
Bhandari, Pradeep
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Kandiah, Kesavan, Subramaniam, Sharmila, Thayalasekaran, Sreedhari, Chedgy, Fergus Jq, Longcroft-wheaton, Gaius, Fogg, Carole, Brown, James F, Smith, Samuel Cl, Iacucci, Marietta and Bhandari, Pradeep (2020) Multicentre randomised controlled trial on virtual chromoendoscopy in the detection of neoplasia during colitis surveillance high-definition colonoscopy (the VIRTUOSO trial). Gut. (doi:10.1136/gutjnl-2020-320980).

Record type: Article

Abstract

Background Longstanding colonic IBD increases the risk of developing colorectal cancer. The utility of chromoendoscopy with standard-definition white light technology has been established. However, the use of high-definition virtual chromoendoscopy (HDV) in colitis surveillance remains undefined. Objective To compare the performance of HDV (i-scan OE mode 2) with high-definition white light (HDWL) for detection of neoplasia in patients with IBD undergoing surveillance colonoscopy. Additionally, we assessed the utility of protocol-guided quadrantic non-targeted biopsies. Design A multioperator randomised controlled trial was carried out in two centres in the UK. Total of 188 patients (101 men, mean age 54) with longstanding ulcerative or Crohn’s colitis were randomised, prior to starting the surveillance colonoscopy, to using either HDV (n=94) or HDWL (n=94) on withdrawal. Targeted and quadrantic non-targeted biopsies were taken in both arms per-randomisation protocol. The primary outcome was the difference in neoplasia detection rate (NDR) between HDV and HDWL. Results There was no significant difference between HDWL and HDV for neoplasia detection. The NDR was not significantly different for HDWL (24.2%) and HDV (14.9%) (p=0.14). All intraepithelial neoplasia (IEN) detected contained low-grade dysplasia only. A total of 6751 non-targeted biopsies detected one IEN only. The withdrawal time was similar in both arms of the study; median of 24 min (HDWL) versus 25.5 min (HDV). Conclusion HDV and HDWL did not differ significantly in the detection of neoplasia. Almost all neoplasia were detected on targeted biopsy or resection. Quadrantic non-targeted biopsies have negligible additional gain. Trial registration number Clinical Trial.gov ID NCT02822352.

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Multicentre randomised controlled trial on virtual chromoendoscopy in the detection of neoplasia during colitis - Accepted Manuscript
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Accepted/In Press date: 12 October 2020
e-pub ahead of print date: 19 November 2020

Identifiers

Local EPrints ID: 446125
URI: http://eprints.soton.ac.uk/id/eprint/446125
ISSN: 0017-5749
PURE UUID: 36234b48-35d4-417e-82ce-2fc159fef4ce
ORCID for Carole Fogg: ORCID iD orcid.org/0000-0002-3000-6185

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Date deposited: 21 Jan 2021 17:34
Last modified: 17 Mar 2024 03:56

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Contributors

Author: Kesavan Kandiah
Author: Sharmila Subramaniam
Author: Sreedhari Thayalasekaran
Author: Fergus Jq Chedgy
Author: Gaius Longcroft-wheaton
Author: Carole Fogg ORCID iD
Author: James F Brown
Author: Samuel Cl Smith
Author: Marietta Iacucci
Author: Pradeep Bhandari

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