Long-Term Follow-Up of Targeted Biopsy Yield (LOFTY Study) in Ulcerative Colitis Surveillance Colonoscopy
Abstract
:1. Introduction
2. Methods
2.1. Initial Randomized Controlled Trial
2.2. Data Collection
2.3. Statistical Analysis
2.4. Ethics
3. Results
3.1. Mortality and Cause of Death
3.2. Colorectal Cancer Development and Fate of Dysplasia Detected in the RCT
3.3. Colectomy Rate
3.4. Extra-Colonic Cancer
3.5. Real-World Surveillance Method After the RCT
4. Discussion
Author Contributions
Funding
Acknowledgments
Conflicts of Interest
Disclosures
Abbreviations
CI | confidence interval |
CRC | colorectal cancer |
CS | colonoscopy |
HGD | high-grade dysplasia |
LGD | low-grade dysplasia |
LOFTY | LOng-term Follow-up of Targeted biopsy Yield |
PSC | primary sclerosing cholangitis |
RCT | randomized controlled trial |
TNF | tumor necrosis factor |
WLE | white light endoscopy |
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Characteristics | Random Group | Target Group | p-Value |
---|---|---|---|
Followed-up cases | n = 93 | n = 102 | |
Neoplasia at RCT | 11 | 9 | |
No neoplasia at RCT | 82 | 93 | |
Age, y, mean (SD) | 48.3 (13.4) | 49.8 (14.0) | 0.447 |
Sex | |||
Female | 29 (31.2%) | 39 (38.2%) | 0.367 |
Male | 64 (68.8%) | 63 (61.8%) | |
Extent of UC | |||
Total colitis | 63 (67.7%) | 57 (55.9%) | 0.207 |
Left-sided colitis | 25 (26.9%) | 39 (38.2%) | |
Others | 5 (5.4%) | 6 (5.9%) | |
Primary sclerosing cholangitis | 0 (0%) | 0 (0%) | |
UC duration at RCT | 16.4 ± 6.9 | 15.8 ± 6.5 | 0.523 |
Smoking history | |||
Never smoked | 52 (55.9%) | 62 (60.8%) | 0.19 |
Current smoker | 8 (8.6%) | 4 (3.9%) | |
Ex-smoker | 9 (9.7%) | 17 (16.7%) | |
Unknown | 24 (25.8%) | 19 (18.6%) | |
Medication at RCT | |||
5 ASA | 86 (92.5%) | 101 (99.0%) | 0.029 |
Steroid | 13 (14.1%) | 15 (14.7%) | 1 |
Apheresis | 12 (12.9% | 20 (19.6%) | 0.247 |
Immunomodulator | 29 (31.2%) | 26 (25.5%) | 0.427 |
Anti-TNFα | 5 (5.4%) | 2 (2.0%) | 0.261 |
Number of biopsies, median (IQR) | |||
At RCT | 36 (29,37) | 3 (2, 8) | <0.001 |
After RCT | 3 (1, 6) | 3 (1, 6) | 0.204 |
Follow-up, y, mean (range) | 8.7 (0.14–10.0) | 8.8 (0.98–10.1) | 0.902 |
Age | Sex | Smoking | Anti-TNF * | Thiopurine * | Primary Site | Status |
---|---|---|---|---|---|---|
60s | M | Current | − | − | Unknown primary | Dead |
50s | M | Current | − | − | Bile duct | Dead |
60s | M | Ex | − | − | Parotid gland | Dead |
70s | M | Ex | − | − | Lung | Dead |
80s | M | Ex | − | − | Lung | Alive |
70s | M | Never | − | − | Pancreas | Alive |
50s | F | Never | − | + | Breast | Alive |
60s | M | Never | − | − | Breast | Alive |
70s | M | Never | − | − | Kidney | Alive |
80s | F | Unknown | − | − | Kidney | Alive |
Group | Sex | Age at RCT | Pathology at RCT | Final Pathology | Interval after RCT (years) | Procedure | Location $ and Morphology at CS | Remarks |
---|---|---|---|---|---|---|---|---|
Random | Female | 50 s | LGD | CRC (T4N0M0) | 5.6 | Colectomy after ESD | R, 0-IIa | Same location † |
Random | Female | 40 s | LGD | Intramucosal Ca | 1.5 | Colectomy after EMR | R, 0-IIa+Is | Additional surgery ‡ |
Random | Male | 60 s | neg | CRC (T1bN0M0) | 4.9 | Colectomy after EMR | T, 0-Isp | Additional surgery ‡ |
Target | Female | 40 s | HGD | LGD | 0.6 | ESD | D, 0-IIa, 0-IIa | Two synchronous lesions § |
Target | Male | 40 s | LGD | CRC (T3N0M0) | 7.2 | Colectomy | S, 0-IIa | Progression? §§ |
Target | Male | 50 s | neg | HGD | 1.8 | Colectomy | R, 0-IIb | |
Target | Female | 30 s | neg | Intramucosal Ca * | 8.6 | ESD | R, 0-IIb |
Variable | n | % |
---|---|---|
Number of colonoscopies | 1085 | |
Biopsy method | ||
Targeted biopsy only | 581 | 59.1% |
Targeted plus random biopsy | 402 | 40.9% |
Number of biopsy specimens | ||
<10 | 1002 | 92.3% |
10–19 | 80 | 7.4% |
20–33 | 2 | 0.2% |
>34 | 1 | 0.1% |
Chromoendoscopy | ||
Panchromoendoscopy | 50 | 4.6% |
Specific area | 295 | 27.4% |
Targeted area only | 169 | 15.7% |
No dye spray | 563 | 52.3% |
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Hata, K.; Ishihara, S.; Ajioka, Y.; Mitsuyama, K.; Watanabe, K.; Hanai, H.; Kunisaki, R.; Nakase, H.; Matsuda, K.; Iwakiri, R.; et al. Long-Term Follow-Up of Targeted Biopsy Yield (LOFTY Study) in Ulcerative Colitis Surveillance Colonoscopy. J. Clin. Med. 2020, 9, 2286. https://doi.org/10.3390/jcm9072286
Hata K, Ishihara S, Ajioka Y, Mitsuyama K, Watanabe K, Hanai H, Kunisaki R, Nakase H, Matsuda K, Iwakiri R, et al. Long-Term Follow-Up of Targeted Biopsy Yield (LOFTY Study) in Ulcerative Colitis Surveillance Colonoscopy. Journal of Clinical Medicine. 2020; 9(7):2286. https://doi.org/10.3390/jcm9072286
Chicago/Turabian StyleHata, Keisuke, Soichiro Ishihara, Yoichi Ajioka, Keiichi Mitsuyama, Kenji Watanabe, Hiroyuki Hanai, Reiko Kunisaki, Hiroshi Nakase, Keiji Matsuda, Ryuichi Iwakiri, and et al. 2020. "Long-Term Follow-Up of Targeted Biopsy Yield (LOFTY Study) in Ulcerative Colitis Surveillance Colonoscopy" Journal of Clinical Medicine 9, no. 7: 2286. https://doi.org/10.3390/jcm9072286