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

Sep 22, 2026

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Aims to compare dysplasia detection performance of high-definition white light endoscopy with random biopsies (HD-WLR) versus high-definition chromoendoscopy (HDCE) in ulcerative colitis (UC) surveillance. UC carries a 2.4-fold increased future colorectal cancer risk, requiring effective dysplasia screening. A retrospective single-center review of UC patients undergoing first CRC screening colonoscopy between January 2019 and 2021 quantified dysplasia detection rates and biopsy burden. HDCE found 20% dysplasia (15/75) versus 4% (3/75) with HD-WLR, with fewer biopsies.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages6

Reading Time15 min

AccessFree to download

Abstract

Introduction

Background: UC, inflammation, and colorectal cancer risk

Study rationale: dysplasia surveillance needs and endoscopic screening modalities

Methods and evaluation (from abstract)

® Observational Study 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 Thomas T. Hoang, MDa , Yvette Leung, MD, FRCPCa ,b , Gregory Rosenfeld, MD, FRCPCa ,b , Brian Bressler, MD, FRCPCa ,b ,* | Abstract
The goal of this study was to determine whether high-definition white light endoscopy with random biopsies (HD-WLR) or chromoendoscopy (HDCE) yielded a higher dysplasia detection rate in ulcerative colitis patients. Ulcerative colitis (UC) patients have a 2.4-fold increased future risk of developing colorectal cancer compared to the general population and require careful dysplasia screening modalities. Both HD-WLR and HDCE are regularly used, and recent guidelines do not suggest a preference. UC patients who underwent dysplasia surveillance at our site between January 2019 and 2021 were retrospectively reviewed. We calculated the dysplasia detection rate of both techniques at the first CRC screening colonoscopy. Eighteen dysplastic lesions were detected in total, 3 by HD-WLR and fifteen by HDCE. Dysplasia was detected in 4%(3/75) and 20%(15/75) of UC patients by HD-WLR and HDCE respectively, with significantly fewer biopsies (4 .44 ± 4.3 vs 29.1 ± 13.0) required using the former. HD-WLR detected 2 polypoid and one non-polypoid lesion, while HDCE detected eleven polypoid and 4 non-polypoid lesions. No invisible dysplasia or colorectal cancer was detected. Screening was performed at 10.8 ± 4.8 and 9.72 ± 3.05 years following UC diagnosis for HDCE and HD-WLR respectively. Median withdrawal time was 9.0 ± 2.7 minutes (HD-WLR) vs 9.6 + 3.9 minutes (HDCE) . HDCE is associated with higher dysplasia detection rates compared to HD-WLR in a UC patient population. Given the former technique is less tedious and costly, our findings complement existing studies that suggest HDCE may be considered over HD-WLR for UC dysplasia surveillance. | | --- | | Abbreviations: 5-ASA = 5-aminosalicylic acid, AGA = American Gastroenterological Association, CRC = colorectal cancer, DCE = dye-spray chromoendoscopy, HDCE = high-definition chromoendoscopy, HD-WLR = high-definition white light endoscopy with random biopsies, IBD = inflammatory bowel disease, IQR = interquartile range, PSC = primary sclerosing cholangitis, RCT = randomized control trial, SCENIC = surveillance for colorectal endoscopic neoplasia detection and management in inflammatory bowel disease patients: International consensus recommendations, SD = standard deviation, UC = ulcerative colitis, WLE = white-light endoscopy. | | Keywords: chromoendoscopy, CRC, dysplasia, non-targeted biopsies, ulcerative colitis | 1. Introduction Ulcerative colitis (UC) is a chronic inflammatory bowel disease that results in inflammation of the colonic mucosa, leading to abdominal pain, rectal bleeding, weight loss, and diarrhea. [1] This chronic inflammation promotes DNA damage and generates reactive oxygen species, leading to increased carcinogenesis in UC patients. [2] As a result, patients with prolonged UC are also at an approximately 2.4-fold increased future risk of developing colorectal cancer (CRC) relative to the general population. [3] TH has no relevant conflicts of interest to disclose. YL has served on advisory boardsand received speaker fees from Janssen, Abbvie, Organon, Pfizer, Takeda, BMS, Amgen, and Eli Lilly. GR has received honoraria from Janssen, Pfizer and Merck asa speaker, adviser and consultant. BB has served on advisory boards and received speaker fees from Ferring, Janssen, Abbvie, Takeda, Pfizer, Novartis, BMS, Merck, Sandoz, Organon, and Lifelabs. BB has served on the advisory boards of Alimentiv, Gilead, Iterative Scopes, AMT, Celgene, Merck, Amgen, Pendopharm, Genentech, BMS, Allergan, Protagonist, Fresenius Kabi, Mylan, Viatris, Bausch Health, Celltrion Healthcare, BioJamp Pharma, and Eupraxia. BB has received r

FAQs

What was the study trying to determine in UC dysplasia surveillance?

The study compared whether HD-WLR or HDCE achieved a higher dysplasia detection rate at the first CRC screening colonoscopy in ulcerative colitis patients.

How did HDCE and HD-WLR differ in dysplasia detection rates?

HDCE detected dysplasia in 20% of UC patients (15/75), while HD-WLR detected dysplasia in 4% (3/75).

Which technique required fewer biopsies during surveillance?

HD-WLR required fewer biopsies than HDCE, with the abstract reporting significantly fewer biopsies when using the former (4.44 ± 4.3 vs 29.1 ± 13.0).

Sep 22, 2026

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