Crohn Disease, Inflammatory Bowel Diseases, Ulcerative Colitis
Conditions
Keywords
IBD, UC, inflammatory bowel diseases, colonoscopy, random biopsies, Crohn's disease, ulcerative colitis
Brief summary
The proposed study is a multicenter parallel group clinical trial that will include 821 evaluable patients per group who will be randomly assigned to either high definition white light colonoscopy (HDWLC) with targeted biopsies plus 2 random biopsies in 4 segments to assess for inflammation (limited biopsy strategy) or HDWLC with targeted biopsies plus 4 biopsies every 10 cm throughout the colon, at a minimum in all segments of the colon known to have been affected by IBD at any time, regardless of the extent of disease (random biopsy strategy). Participants will be followed until total proctocolectomy or the end of the study period to determine whether the two methods of surveillance colonoscopy are associated with detection of dysplasia or sessile serrated adenoma at follow-up colonoscopy. Follow-up via chart review may continue for up to 15 years from enrollment.
Detailed description
To maximize the yield of surveillance colonoscopy, minimize risk to patients, and deliver cost-effective care, it is imperative to resolve whether random biopsies are warranted for patients with long standing Inflammatory Bowel Disease (IBD) undergoing dysplasia and colorectal cancer (CRC) surveillance with high-definition white light colonoscopy (HDWLC). For this protocol, dysplasia surveillance refers to the process of identifying precancerous dysplasia, sessile serrated adenoma (SSA) or CRC. This protocol describes a pragmatic, multicenter randomized trial of patients with IBD undergoing dysplasia surveillance with HDWLC, the most common type of surveillance colonoscopy performed in the US, to definitively answer this question. The primary objective of the study is to determine if HDWLC using a limited biopsy strategy is non-inferior to HDWLC using a random biopsy strategy to detect dysplasia or sessile serrated adenoma (SSA) in patients with IBD. Secondary objectives include: 1. Determine if HDWLC using a limited biopsy strategy is superior to HDWLC with a random biopsy strategy to detect one or more dysplastic or SSA lesion in patients with IBD 2. Determine whether the number of targeted biopsies differs based on the number of random biopsies obtained.
Interventions
OTHERBiopsy strategy
Number of random biopsies, in addition to targeted biopsies, taken during colonoscopies where at least one indication for the colonoscopy is surveillance for dysplasia
Sponsors
Abramson Cancer Center at Penn Medicine
National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
PREVENTION
Masking
NONE
Masking description
The endoscopist will not be informed of the biopsy strategy until he/she is ready to insert the scope. Participants will not be informed of the randomization until the colonoscopy is completed.
Intervention model description
multicenter parallel group clinical trial
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Diagnosis of left-sided (greater than 15 cm of disease but not beyond the splenic flexure) or extensive (extending beyond the splenic flexure) ulcerative colitis or IBD-U or colonic Crohn's disease involving at least 1/3 of the colon (defined as 2 segments of the remaining colon; segments include right colon, transverse colon, left colon and rectum). * Disease duration must meet one of the following criteria: 1. onset of symptoms of IBD at least 8 years prior 2. diagnosis of IBD at least 8 years prior 3. diagnosis of IBD for any duration if other risk factors for colon cancer are present including: concomitant diagnosis of primary sclerosing cholangitis, personal history of dysplasia, sessile serrated adenoma or right sided hyperplastic polyps greater than 10mm in diameter, or a family history of colon cancer in a first degree relative or two second degree relatives. * Scheduled to undergo colonoscopy as part of routine care * At least one indication for the index colonoscopy must be to perform dysplasia surveillance.
Exclusion criteria
* Any condition that the endoscopist feels is a contraindication to random biopsies * History of visible (high or low grade) dysplasia not completely removed * History of sessile serrated adenoma not completely removed * History of colorectal cancer * Any condition for which the endoscopist feels that pancolonic contrast or virtual chromoendoscopy is mandatory * Less than 2 segments of the remaining colon have ever been involved with IBD * Colonoscopy\* in the last 11 months unless the colonoscopy: 1. was determined by the endoscopist to be insufficient for dysplasia surveillance and, 2. did not include a diagnosis of dysplasia or sessile serrated adenoma. \*Does not include sigmoidoscopy * Inability to provide informed consent
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| number of dysplastic or SSA lesions detected per colonoscopy | At index colonoscopy | The rationale for this as the primary outcome is that it is important to detect and remove all precancerous lesions. For this outcome, the investigators will include low grade dysplasia (LGD), high grade dysplasia (HGD), SSA or CRC but not indefinite for dysplasia (IFD). Dysplasia will include both conventional and nonconventional forms of dysplasia. Although SSAs do not typically have histologic changes of dysplasia, they are considered precancerous lesions and are more difficult to detect than sporadic adenomatous polyps. The number of dysplastic or SSA lesions will be defined as the number of pathology jars containing a specimen with low-grade or high-grade dysplasia (including CRC) or serrated changes consistent with a sessile serrated adenoma-like change. Even if there are more than one biopsy sample in a jar with dysplasia or SSA, it will be counted as one location with dysplasia or SSA. |
Countries
United States
Contacts
PRINCIPAL_INVESTIGATORJames D Lewis, MD, MSCE
University of Pennsylvania
Outcome results
None listed