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

Kesavan Kandiah, Sharmila Subramaniam, Sreedhari Thayalasekaran, Fergus Jq Chedgy, Gaius Longcroft-Wheaton, Carole Fogg, James F Brown, Samuel Cl Smith, Marietta Iacucci, Pradeep Bhandari, Kesavan Kandiah, Sharmila Subramaniam, Sreedhari Thayalasekaran, Fergus Jq Chedgy, Gaius Longcroft-Wheaton, Carole Fogg, James F Brown, Samuel Cl Smith, Marietta Iacucci, Pradeep Bhandari

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.

Keywords: Crohn's colitis; chronic ulcerative colitis; colonoscopy; colorectal neoplasia; surveillance.

Conflict of interest statement

Competing interests: None declared.

© Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.

Figures

Figure 1
Figure 1
Study flowchart. CC, Crohn’s colitis; HDV, high-definition virtual chromoendoscopy; HDWLE, high-definition white light.
Figure 2
Figure 2
Example of a neoplastic lesion detected with HDWL and HDV. In picture (A), the lesion is seen using HDWL and in picture (B), the same lesion is seen using HDV. The histology of this lesion was tubular adenoma with low grade dysplasia. HDV, high-definition virtual chromoendoscopy; HDWLE, high-definition white light.

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