Virtual chromoendoscopy vs standard dye-based chromoendoscopy in Inflammatory Bowel Disease (IBD) surveillance.

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Dysplasia is an important precursor to bowel cancer in IBD, which can be very challenging to detect. Previous studies suggest that dysplasia is detected in approximately 9% of colonoscopies performed for IBD surveillance. Dye-based chromoendoscopy (DBC) which involves spraying the entire colon with contrast materia such as indigo carmine or methylene blue is thought of as the current gold standard for dysplasia detection. However, dye-based chromoendoscopy is expensive, time consuming and difficult to perform, which limits its use as a surveillance test. A routine survey of Australian Gastroenetrologists suggests that more than half did not use the dye-spray technique. Virtual chromoendoscopy with Pentax i-scan Optical Enhancement(OE) uses in-built technology in the endoscope processor with the same principles as dye-based chromoendoscopy to enhance colonic mucosal pit and vessel pattern. We therefore hypothesise that virtual chromoendoscopy is non-inferior to dye spray chromoendoscopy in detecting dysplasia. It will also consume less resources and time. The aim of our study is to compare virtual and dye-based chromoendoscopy in a prospective tandem colonoscopy study. Research design & methods: We plan to conduct a prospective study, enrolling patients with known IBD who are due to have their standard surveillance colonoscopy to look for dysplasia. A tandem colonoscopy model will be used. Enrolled participants will have a colonoscopy using virtual chromoendoscopy with i-scan OE first during insertion and withdrawal. All lesions detected will be removed or biopsied, as appropriate. On completion of withdrawal, a second look will be performed with dye-spraying as is the current clinical practice. This will allow any additional pathology detected to be treated.

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