Back-to-back Endoscopy Versus Single-pass Endoscopy and Chromoendoscopy in IBD Surveillance
- Conditions
- Inflammatory Bowel DiseasesColorectal Neoplasms
- Registration Number
- NCT04291976
- Lead Sponsor
- Radboud University Medical Center
- Brief Summary
The current international guidelines for CRC surveillance in IBD recommend as first choice the use of chromoendoscopy, and as an alternative high-definition white light endoscopy (HDWLE) for optimal dysplasia detection, based on data from clinical trials. However, data on the superiority of CE over HDWLE are not consistent in literature. The investigators hypothesize that the better performance of CE in some clinical trials is the result of the associated longer procedural time and the fact that every colon segment is examined twice. Currently, no studies have been published evaluating the dysplastic yield of back-to back HDWLE compared to HDWLE with a single pass or CE in patients with IBD. In the present study, the investigators aim to compare the yield of dysplasia/CRC between 1) regular HDWLE, 2) HDWLE back-to-back, and 3) CE.
- Detailed Description
The investigators assume based on previous research a yield of 12% using high-definition white light endoscopy and 24% using either chromoendoscopy or high-definition white light endoscopy with a second examination (Imperatore et al 2019). To show non-inferiority of back-to-back HDWLE compared to CE, with a non-inferiority margin of 10% (power 80% and alpha 5%,) a total of 226 patients per group is required.
To demonstrate a superiority of back-to-back HDWLE compared to a regular HDWLE, with a 1:2 allocation ratio of single-pass vs back-to-back , 113 and 226 patients per group are needed to achieve 80% power with an alpha of 5%. Therefore, the investigators will include 226 patients in group back-to-back HDWLE, 226 in group CE, and 113 patients in group regular HDWLE. This amounts to a total of 560 patients. To account for any screen-failures The investigators will include at most 5% (of 560) additional patients until 80% power is reached.
Recruitment & Eligibility
- Status
- COMPLETED
- Sex
- All
- Target Recruitment
- 563
- Signed informed consent
- Patients with inflammatory bowel disease, an estimated involvement of at least 30% of the colonic surface and a disease duration of at least 8 years (or any disease duration in case of concomitant primary sclerosing cholangitis).
- Previous assessable surveillance endoscopy > 1 year
- Age > 18 years
- Active colitis > 20 cm and/or inflammation resulting in an insufficient surveillance procedure according to the endoscopist.
- Allergy or intolerance to methylene blue
- Insufficient bowel cleansing (BBPS <6)
- Refusing or incapable to agree with informed consent
- Pregnant women
- > 50 % of the colon surgically removed
Study & Design
- Study Type
- INTERVENTIONAL
- Study Design
- PARALLEL
- Primary Outcome Measures
Name Time Method detection rate of neoplasia for each technique During endoscopy
- Secondary Outcome Measures
Name Time Method Number of all lesions for each technique During endoscopy Number of dysplastic lesions for each technique After each endoscopy, within one month after the procedure. Kudo classification for each lesion During endoscopy when a lesion is detected Duration During endoscopy Total endoscopic procedure time and endoscopic procedure time during withdrawal for each technique.
Number of targeted biopsies taken in the different groups. During endoscopy Percentage of non-interpretable/assessable endoscopies During endoscopy e.g. insufficient preparation, inflammation
Size of the lesion in mm During endoscopy Location of the lesion During endoscopy
Trial Locations
- Locations (4)
Radboudumc
🇳🇱Nijmegen, Gelderland, Netherlands
Utrecht University Medical Center
🇳🇱Utrecht, Gelderland, Netherlands
Amsterdam UMC, location AMC
🇳🇱Amsterdam, Noord-Holland, Netherlands
Leiden University Medical Center
🇳🇱Leiden, Zuid Holland, Netherlands
Radboudumc🇳🇱Nijmegen, Gelderland, Netherlands