Does high‑definition white‑light colonoscopy with targeted biopsies detect dysplasia at a higher rate than conventional chromoendoscopy in patients with long‑standing UC

What is known

- A multicenter RCT concluded chromoendoscopy with targeted biopsies is superior to white-light endoscopy for long-term dysplasia detection in UC. ¹ - In that RCT, chromoendoscopy with targeted biopsies diagnosed dysplasia on more colonoscopies than white-light with targeted biopsies (13.3% vs 1.6%). ¹ - A single-center retrospective study found high-definition chromoendoscopy detected dysplasia in more patients (20% vs 4%) than white-light with random biopsies, using fewer biopsies. ² - A meta-analysis reported chromoendoscopy with targeted biopsies was far more likely to detect dysplasia than white-light with random biopsies. ³

What is unknown / caveats

- A large retrospective study found chromoendoscopy did not increase neoplasia detection versus conventional colonoscopy with random biopsies ^3,4 - Recent guidelines cited do not express a preference between the two techniques ² - Available direct comparisons pair chromoendoscopy-targeted against white-light-random more often than against white-light-targeted - Chromoendoscopy is described as technically challenging and time-consuming ⁵ - Data directly comparing high-definition white-light with targeted biopsies against chromoendoscopy are limited, and findings across studies are not fully consistent.

## References

1. Wan J, Zhang Q, Liang SH, Zhong J, Li JN, Ran ZH, Zhi FC, Wang XD, Zhang XL, Wen ZH, Sheng JQ, Shi HX, Mei Q, Wu KC. Chromoendoscopy with targeted biopsies is superior to white-light endoscopy for the long-term follow-up detection of dysplasia in ulcerative colitis patients: a multicenter randomized-controlled trial. Gastroenterol Rep (Oxf). 2021. PMID: 33747522.

2. Hoang TT, Leung Y, Rosenfeld G, Bressler B. High-definition chromoendoscopy results in more significant dysplasia detection than white light endoscopy with random biopsies in ulcerative colitis patients: A single-center retrospective study. Medicine (Baltimore). 2024. PMID: 38306575.

3. Sengupta, Neil, Yee, Eric, Feuerstein, Joseph D. Colorectal Cancer Screening in Inflammatory Bowel Disease. Dig Dis Sci. 2016;61:980-9. PMID: 26646250.

4. Verdon C, Aruljothy A, Lakatos PL, Bessissow T. Endoscopic surveillance strategies for dysplasia in ulcerative colitis. Frontline Gastroenterol. 2020. PMID: 32133111.

5. Yang DH, Park SJ, Kim HS, Park YS, Park DI, Lee KM, Jung SA, Choi CH, Koo JS, Cheon JH, Yang SK, Kim WH, Kim J, Kim H, Ryan Choi CH, Korean Association for the Study of the Intestinal Diseases (KASID) S. High-Definition Chromoendoscopy Versus High-Definition White Light Colonoscopy for Neoplasia Surveillance in Ulcerative Colitis: A Randomized Controlled Trial. Am J Gastroenterol. 2019. PMID: 31567166.

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_Draft, generated by the IBDology RAG and not yet clinician-reviewed. Answers are grounded in the retrieved literature listed above; a high faithfulness score means the answer matches its sources, not that the sources are correct._