HD White-Light Endoscopy with Reinspection Matches HD Chromoendoscopy in Detecting Neoplasia in IBD

A multicenter randomized controlled trial comparing surveillance techniques for colorectal neoplasia in inflammatory bowel disease (IBD) patients found that high-definition (HD) white-light endoscopy with segmental reinspection is noninferior to HD dye-based chromoendoscopy.

The trial included 563 patients with IBD, aged 18 years or older, all in clinical remission and scheduled for endoscopic surveillance. Patients were randomized into 3 groups: HD white-light endoscopy with segmental reinspection (double-pass), HD chromoendoscopy, and single-pass HD white-light endoscopy as a control. The primary outcome was colorectal neoplasia detection rates.

Detection rates were 10.3% for HD white-light endoscopy with segmental reinspection and 13.1% for HD chromoendoscopy, confirming noninferiority of the white-light approach (Δ−2.8%, lower limit 95% CI −7.8, *p* < 0.01). Additionally, both methods yielded comparable neoplasia detection rates per 10 minutes of withdrawal time (0.062 vs. 0.058, *p* = 0.83).

The single-pass HD white-light endoscopy group demonstrated a lower detection rate (6.1%), but the difference compared to segmental reinspection was not statistically significant (Δ4.1%, 95% CI −2.2 to 9.6%, *p* = 0.19).

“HD white-light endoscopy with segmental re-inspection offers similar detection rates to HD chromoendoscopy, suggesting the benefit of chromoendoscopy may be explained by longer inspection times,” the authors stated.

However, the study noted that reinspection itself did not significantly increase detection rates compared to single-pass white-light endoscopy.

Reference
Te Groen M, Wijnands AM, den Broeder N, et al. Surveillance in inflammatory bowel disease: white light endoscopy with segmental re-inspection versus dye-based chromoendoscopy - a multi-arm randomised controlled trial (HELIOS). Gut. Published online January 16, 2025. doi:10.1136/gutjnl-2024-333446