Gastroenterology · Medical Literature
Comparison of methylene blue dye-based chromoendoscopy and Fujifilm virtual chromoendoscopy (blue light imaging and linked color imaging) for dysplasia detection in inflammatory bowel disease: a prospective single-center randomized study.
Abstract
BACKGROUND: Dye-based chromoendoscopy is recommended for dysplasia surveillance in inflammatory bowel disease (IBD), but virtual chromoendoscopy systems are increasingly used as practical alternatives. Prospective data directly comparing these techniques on a single imaging platform remain limited. This study aimed to compare dysplasia detection using methylene blue dye-based chromoendoscopy (MB-CE) and Fujifilm virtual chromoendoscopy (blue light imaging [BLI] and linked color imaging [LCI]) during IBD surveillance colonoscopy. METHODS: This was a prospective, randomized, single-center study conducted at Al Adan Hospital, Kuwait. Three hundred adult patients with ulcerative colitis or Crohn’s colitis scheduled for surveillance colonoscopy were randomized 1:1 to MB-CE or BLI/LCI (150 per group). All procedures were performed on Fujifilm ELUXEO systems by a single experienced endoscopist. Targeted biopsies were obtained from all visible lesions, with additional random biopsies every 10 cm. Multivariable logistic regression identified independent predictors of dysplasia detection. RESULTS: Dysplasia was detected in 30 of 300 patients (10.0%). The MB-CE group had a significantly higher per-patient dysplasia detection rate than the BLI/LCI group (12% vs. 8%; p = 0.04). Lesions detected by MB-CE were more frequently flat and located in the proximal colon. On multivariable analysis, MB-CE, disease duration ≥ 10 years, pancolitis, primary sclerosing cholangitis, and exposure to biologic or immunosuppressive therapy were independently associated with dysplasia detection. CONCLUSIONS: Within the Fujifilm ELUXEO platform, MB-CE detected more dysplasia than BLI/LCI, particularly flat and right-sided lesions in high-risk patients. Dye-based chromoendoscopy should remain the preferred surveillance technique in high-risk IBD populations, while virtual chromoendoscopy may be considered in selected lower-risk settings. TRIAL REGISTRATION: ISRCTN, ISRCTN10174296. Registered 9 March 2026, https://www.isrctn.com/ISRCTN10174296 .
Clinical relevance
In adult patients with ulcerative colitis or Crohn's colitis undergoing surveillance colonoscopy on the Fujifilm ELUXEO platform, does methylene blue dye-based chromoendoscopy (MB-CE) detect dysplasia more effectively than Fujifilm virtual chromoendoscopy using blue light imaging (BLI) and linked color imaging (LCI)? __SNAPSHOT__ {"studyDesign":"Prospective, single-center, randomized controlled trial","setting":"Al Adan Hospital, Ministry of Health, Kuwait City, Kuwait (single tertiary-care endoscopy unit)","sampleSize":"n=300 (MB-CE: n=150; BLI/LCI: n=150)","population":"Adult patients with ulcerative colitis or Crohn's colitis scheduled for IBD surveillance colonoscopy; specific inclusion/exclusion criteria (e.g., disease duration, disease activity thresholds, prior dysplasia history) not fully reported in the available abstract","intervention":"Methylene blue dye-based chromoendoscopy (MB-CE) using the Fujifilm ELUXEO colonoscope platform, with targeted biopsies of all visible lesions plus random biopsies every 10 cm","comparator":"Fujifilm virtual chromoendoscopy combining blue light imaging (BLI) and linked color imaging (LCI) on the same ELUXEO platform, with an identical biopsy protocol","primaryOutcome":"Dysplasia detection rate (proportion of patients with at least one histologically confirmed dysplastic lesion); multivariable logistic regression was also used to identify independent predictors of dysplasia detection","followUp":"Not reported (single-procedure, cross-sectional endpoint)","fundingSource":"No external financial support received (investigator-initiated)"}
Key findings
Dysplasia was detected in 30 of 300 patients (10.0% overall). The MB-CE group had a significantly higher dysplasia detection rate than the BLI/LCI group; the exact per-arm rates, absolute risk difference, relative risk, odds ratio, confidence intervals, and p-value are not reported in the available abstract. NNT is therefore not calculable from available data. The authors report that MB-CE was superior particularly for flat lesions and right-sided (proximal colon) lesions, and that this advantage was most pronounced in high-risk patients. Independent predictors of dysplasia detection were identified by multivariable logistic regression; specific predictor variables, odds ratios, and confidence intervals from this model are not reported in the available abstract. Adverse event data, procedure time comparisons, and biopsy yield details are not reported in the available abstract. NOTE: Only the truncated abstract and publicly accessible summary conclusions were available for this review; full numerical results were not accessible.
Practice implications
This prospective RCT provides direct, same-platform evidence that MB-CE outperforms Fujifilm BLI/LCI for dysplasia detection in IBD surveillance colonoscopy, particularly for flat and right-sided lesions in high-risk patients. This finding is clinically relevant because prior virtual chromoendoscopy studies, including retrospective data comparing LCI to dye chromoendoscopy (showing comparable neoplasia detection rates), were conducted on mixed or different platforms, making cross-platform inference uncertain. The study partially addresses a recognized evidence gap: prospective head-to-head comparisons of dye-based and virtual chromoendoscopy on a single manufacturer's platform. However, several important limitations constrain interpretation. The study was conducted at a single center in Kuwait by a single experienced endoscopist, limiting generalizability to community or lower-volume settings. Whether results apply equally to patients with low disease activity, short disease duration, or without high-risk features (e.g., prior dysplasia, PSC) cannot be determined from the available abstract. The trial was registered prospectively (ISRCTN10174296) but registered in March 2026, the same year as publication, raising questions about registration timing relative to enrollment. The authors conclude that dye-based chromoendoscopy should remain preferred in high-risk IBD populations, while virtual chromoendoscopy may be considered in selected lower-risk settings — a nuanced recommendation that is consistent with existing guideline frameworks but not definitively supported by lower-risk subgroup data from this study alone. IMPORTANT CAVEAT: This summary is based on the truncated abstract provided and publicly accessible conclusions only; full results including all effect sizes, confidence intervals, p-values, subgroup analyses, and safety data were not available for review. __LIMITATIONS__ Single-center design conducted by a single experienced endoscopist at a tertiary referral hospital in Kuwait, severely limiting generalizability to community endoscopy settings and other geographic populations,Single-endoscopist design eliminates inter-operator variability but introduces substantial operator performance bias; results may not be reproducible by less experienced endoscopists or those less familiar with MB-CE,Prospective trial registration (ISRCTN10174296) was recorded in March 2026, the same month as or shortly before publication — the relationship of registration timing to patient enrollment cannot be confirmed from available data, raising potential risk of selective outcome reporting,Exact per-arm dysplasia detection rates, effect sizes (absolute risk difference, RR, OR), confidence intervals, and p-values are not available in the truncated abstract, precluding independent assessment of statistical precision or clinical magnitude of the observed difference,Overall dysplasia detection rate of 10.0% suggests a relatively high-risk study population; it is unclear whether results are applicable to lower-risk IBD surveillance populations who represent the majority of routine clinical practice,No reported follow-up beyond the index procedure; it is unknown whether MB-CE's apparent advantage in dysplasia detection translates to improved long-term outcomes (e.g., prevention of colorectal cancer, cancer-related mortality),The BLI and LCI modalities were used in combination rather than individually, making it impossible to distinguish the independent contribution of each virtual chromoendoscopy mode,Blinding of the endoscopist was not possible given the nature of the interventions; histopathologic review blinding is not described in the available abstract,No funding disclosures of concern, but the study was conducted entirely within the Fujifilm ELUXEO platform ecosystem; no independent assessment of competing platforms (e.g., Olympus NBI, Pentax i-SCAN) was included,Absence of a white-light endoscopy comparator arm prevents estimation of the incremental benefit of either chromoendoscopy modality over standard HD-WLE in this population __BOTTOM_LINE_CATEGORY__ potentially_practice_informing __BOTTOM_LINE__ Within the Fujifilm ELUXEO platform, methylene blue dye-based chromoendoscopy detected significantly more dysplasia than BLI/LCI combined during IBD surveillance colonoscopy, with the advantage most pronounced for flat and right-sided lesions in high-risk patients. Given the single-center, single-endoscopist design and unavailability of full effect-size data, these findings support maintaining dye-based chromoendoscopy as the preferred modality for high-risk IBD surveillance while suggesting virtual chromoendoscopy may be a reasonable alternative in lower-risk settings — a conclusion that requires validation in multicenter trials before broadly informing practice change.