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

Background: Longstanding colonic inflammatory bowel disease (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 IBD patients undergoing surveillance colonoscopy. Additionally we assessed the utility of protocol guided quadrantic nontargeted biopsies.

Design: A multi-operator randomised controlled trial was carried out in two centres in the United Kingdom. 188 patients (101 male, mean age 54) with long standing 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 1 IEN only. The withdrawal time was similar in both arms of the study; median of 24 minutes (HDWL) vs 25.5 minutes (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.