Does chromoendoscopy improve dysplasia detection rates compared to standard white-light colonoscopy in UC

What is known

- The SCENIC international consensus considered dye chromoendoscopy the most sensitive modality for dysplasia detection in IBD, and multiple studies show it increases detection with targeted biopsies. ¹ - Meta-analyses of randomized trials have reported higher dysplasia detection with dye chromoendoscopy, but those trials used mainly standard-definition white light as the comparator; against high-definition white light the advantage has generally not been reproduced. (Source not identified among the references listed below.) - A GRADE assessment rated the benefit of HD dye-based chromoendoscopy over HD white light as small in per-patient dysplasia detection, with low overall certainty. ²

What is unknown / caveats

- A large retrospective study found dye chromoendoscopy did not increase neoplasia detection compared with white-light endoscopy with targeted or random biopsies ¹ - Modern high-definition white-light endoscopy narrows the gap; a network meta-analysis found HD white light itself outperforms standard-definition white light ² - Much of the comparison is against standard-definition rather than high-definition white light, and the two eras are not clearly separated - Chromoendoscopy is operator-dependent, needs good bowel prep and longer procedure time, and inflammation or pseudopolyps can degrade images ³ - Chromoendoscopy has not been shown to improve colorectal cancer mortality ³ - The absolute added yield appears small and the certainty is low, with at least one large study finding no advantage.

## References

1. Gasia MF, Ghosh S, Panaccione R, Ferraz JG, Kaplan GG, Leung Y, Novak KL, Seow CH, Iacucci M. Targeted Biopsies Identify Larger Proportions of Patients With Colonic Neoplasia Undergoing High-Definition Colonoscopy, Dye Chromoendoscopy, or Electronic Virtual Chromoendoscopy. Clin Gastroenterol Hepatol. 2016;14(5):704-12.e4. PMID: 26804384.

2. Ten Hove JR, Mooiweer E, Dekker E, van der Meulen-de Jong AE, Offerhaus GJ, Ponsioen CY, Siersema PD, Oldenburg B. Low Rate of Dysplasia Detection in Mucosa Surrounding Dysplastic Lesions in Patients Undergoing Surveillance for Inflammatory Bowel Diseases. Clin Gastroenterol Hepatol. 2017;15(2):222-228.e2. PMID: 27613257.

3. Galanopoulos M, Tsoukali E, Gkeros F, Vraka M, Karampekos G, Matzaris GJ. Screening and surveillance methods for dysplasia in inflammatory bowel disease patients: Where do we stand?. World J Gastrointest Endosc. 2018;10(10):250-258. PMID: 30364842.

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_Draft, generated by the IBDology RAG and not yet clinician-reviewed. Answers are grounded in the retrieved literature listed above; a high faithfulness score means the answer matches its sources, not that the sources are correct._