SUBTLE VILLOUS CHANGES DETECTED AT ENDOSCOPY IN PATIENTS WITH INFLAMMATORY BOWEL DISEASE

Dysplastic areas in flat mucosa in patients with inflammatory bowel disease (IBD) are difficult to detect at endoscopic examination. We describe the endoscopic and clinicopathological characteristics of colorectal mucosa with subtle villous changes (SVC) detected by endoscopy and chromoscopy in patients with IBD. The present study consists of 18 IBD patients. The age at onset of the disease, duration and extent of disease, endoscopic features, and clinical follow up were noted. Of the 18 patients, 12 had ulcerative colitis and six had Crohn's colitis. The mean duration from onset of disease to the detection of SVC was 25.4 years (range 4–50 years). All patients had extensive colitis. All SVC areas were present in colorectal segments having absent vascular pattern and decrease or loss of normal folds. Mucosal redness was frequently observed. Following indigo carmine dye spraying the SVC were characterized by a subtle villous surface resembling small intestinal mucosa. Biopsies taken from SVC areas showed dysplasia in nine of the 18 patients (50.0%): LGD in seven and HGD in two. SVC can be identified with endoscopy and chromoscopy. The endoscopic identification of SVC areas may increase the accuracy in detecting epithelial dysplasia in biopsies from patients with IBD.