Lay Summary
Proposal No. IBD-0219
Principal Investigator: David Paul Hurlstone, MB ChB, M.D.
Applicant Organization: Sheffield Teaching Hospitals NHS Foundation Trust (England, United Kingdom)
Project Title: A randomized Phase II clinical trial to investigate the diagnostic utility of confocal chronoscopic endomicroscopy for the detection and characterization of intraepithelial neoplasia in chronic ulcerative colitis
Period of Award: October 8, 2007 - October 7, 2008
Patients with longstanding chronic ulcerative colitis are ‘at risk’ of developing colorectal cancer. Approximately one in six patients will die as a result of colorectal malignancy, which can often be difficult to detect using conventional ‘white light’ colonoscopy. New endoscopic techniques and technologies including the use of dye sprays ‘chromoendoscopy’ and recently confocal laser scanning or ‘endomicroscopy’ have now been introduced in an attempt to improve the diagnosis of early cancer and it’s precursors at screening colonoscopy, where published studies suggest many significant pre-cancerous and cancerous abnormalities are missed. This is of utmost clinical importance as patients with early cancerous changes in the colon will in 95% of cases be alive at five years following diagnosis in comparison to less than 50% of patients who present with advanced colorectal cancer.
Confocal endomicroscopy is an adaption to a conventional working colonoscope (flexible video camera) and is integration into the moving tip, enabling extremely high resolution imaging of both the surface layer of the colon and the deeper vascular layers of the colon wall. Dye sprayed onto the colon lining serves to highlight subtle changes in the bowel wall that can then be analysed in great detail using the confocal adaption system at the same time as the ongoing video endoscopy. Biopsies can then be targeted to the abnormal bowel wall with great precision as the confocal system gives equivalent detail to that seen by a pathologist when examining tissue under the high powered ‘bench top’ microscope.
We suspect, that using dye spray in addition to confocal imaging may increase the total number of pre-cancerous and cancerous abnormalities detected in patients with chronic ulcerative colitis as compared to dye spray or multiple blinded biopsies (the current technique) alone.
Should our study show an increase in the detection of such pre-cancerous and early cancerous abnormalities, this will have a profound effect on survival for patients diagnosed with colitis associated colon cancer. The research may also change the current investigation pathway in patients undergoing screening colonoscopy who are at risk of colitis-associated cancer to that of dye spray and laser scanning, where potentially many lives can be saved.