Utility of Random Biopsies in Patients With Inflammatory Bowel Disease

NCT ID: NCT06560021

Last Updated: 2025-11-06

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

ENROLLING_BY_INVITATION

Clinical Phase

NA

Total Enrollment

1642 participants

Study Classification

INTERVENTIONAL

Study Start Date

2024-12-11

Study Completion Date

2029-06-30

Brief Summary

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The proposed study is a multicenter parallel group clinical trial that will include 821 evaluable patients per group who will be randomly assigned to either high definition white light colonoscopy (HDWLC) with targeted biopsies plus 2 random biopsies in 4 segments to assess for inflammation (limited biopsy strategy) or HDWLC with targeted biopsies plus 4 biopsies every 10 cm throughout the colon, at a minimum in all segments of the colon known to have been affected by IBD at any time, regardless of the extent of disease (random biopsy strategy). Participants will be followed until total proctocolectomy or the end of the study period to determine whether the two methods of surveillance colonoscopy are associated with detection of dysplasia or sessile serrated adenoma at follow-up colonoscopy. Follow-up via chart review may continue for up to 15 years from enrollment.

Detailed Description

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To maximize the yield of surveillance colonoscopy, minimize risk to patients, and deliver cost-effective care, it is imperative to resolve whether random biopsies are warranted for patients with long standing Inflammatory Bowel Disease (IBD) undergoing dysplasia and colorectal cancer (CRC) surveillance with high-definition white light colonoscopy (HDWLC). For this protocol, dysplasia surveillance refers to the process of identifying precancerous dysplasia, sessile serrated adenoma (SSA) or CRC. This protocol describes a pragmatic, multicenter randomized trial of patients with IBD undergoing dysplasia surveillance with HDWLC, the most common type of surveillance colonoscopy performed in the US, to definitively answer this question.

The primary objective of the study is to determine if HDWLC using a limited biopsy strategy is non-inferior to HDWLC using a random biopsy strategy to detect dysplasia or sessile serrated adenoma (SSA) in patients with IBD.

Secondary objectives include:

1. Determine if HDWLC using a limited biopsy strategy is superior to HDWLC with a random biopsy strategy to detect one or more dysplastic or SSA lesion in patients with IBD
2. Determine whether the number of targeted biopsies differs based on the number of random biopsies obtained.

Conditions

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Inflammatory Bowel Diseases Crohn Disease Ulcerative Colitis

Keywords

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IBD UC inflammatory bowel diseases colonoscopy random biopsies Crohn's disease ulcerative colitis

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

multicenter parallel group clinical trial
Primary Study Purpose

PREVENTION

Blinding Strategy

NONE

The endoscopist will not be informed of the biopsy strategy until he/she is ready to insert the scope. Participants will not be informed of the randomization until the colonoscopy is completed.

Study Groups

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Limited biopsy strategy

Targeted biopsies plus 2 random biopsies in 2 segments to assess for inflammation

Group Type ACTIVE_COMPARATOR

Biopsy strategy

Intervention Type OTHER

Number of random biopsies, in addition to targeted biopsies, taken during colonoscopies where at least one indication for the colonoscopy is surveillance for dysplasia

Random biopsy strategy

Targeted biopsies plus 4 biopsies every 10 cm throughout the colon, at a minimum in all segments of the colon known to have been affected by IBD at any time

Group Type ACTIVE_COMPARATOR

Biopsy strategy

Intervention Type OTHER

Number of random biopsies, in addition to targeted biopsies, taken during colonoscopies where at least one indication for the colonoscopy is surveillance for dysplasia

Interventions

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Biopsy strategy

Number of random biopsies, in addition to targeted biopsies, taken during colonoscopies where at least one indication for the colonoscopy is surveillance for dysplasia

Intervention Type OTHER

Eligibility Criteria

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Inclusion Criteria

* Diagnosis of left-sided (greater than 15 cm of disease but not beyond the splenic flexure) or extensive (extending beyond the splenic flexure) ulcerative colitis or IBD-U or colonic Crohn's disease involving at least 1/3 of the colon for at least 8 years
* Patients who are scheduled to undergo colonoscopy as part of routine care.
* At least one indication for the index colonoscopy must be to perform dysplasia surveillance.
* Has not had a colonoscopy in the last 11 months

Exclusion Criteria

* Any condition that the endoscopist feels is a contraindication to random biopsies
* History of visible (high or low grade) dysplasia not completely removed
* History of sessile serrated adenoma not completely removed
* History of colorectal cancer
* Any condition for which the endoscopist feels that pancolonic contrast or virtual chromoendoscopy is mandatory
* Inability to provide informed consent
Minimum Eligible Age

18 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)

NIH

Sponsor Role collaborator

Abramson Cancer Center at Penn Medicine

OTHER

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Principal Investigators

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James D Lewis, MD, MSCE

Role: PRINCIPAL_INVESTIGATOR

University of Pennsylvania

Locations

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University of Alabama Birmingham

Birmingham, Alabama, United States

Site Status

University of California, Los Angeles

Los Angeles, California, United States

Site Status

Scripps Health

San Diego, California, United States

Site Status

University of Colorado

Aurora, Colorado, United States

Site Status

Mayo Clinic Jacksonville

Jacksonville, Florida, United States

Site Status

AdventHealth

Orlando, Florida, United States

Site Status

Northwestern University

Chicago, Illinois, United States

Site Status

Mercy Medical Center

Baltimore, Maryland, United States

Site Status

University of Michigan

Ann Arbor, Michigan, United States

Site Status

Mayo Clinic Rochester

Rochester, Minnesota, United States

Site Status

NYU Langone Health

New York, New York, United States

Site Status

University of Rochester

Rochester, New York, United States

Site Status

University of North Carolina

Chapel Hill, North Carolina, United States

Site Status

University of Pennsylvania

Philadelphia, Pennsylvania, United States

Site Status

University of Pittsburgh

Pittsburgh, Pennsylvania, United States

Site Status

Allegheny Health Network

Pittsburgh, Pennsylvania, United States

Site Status

University of Utah

Salt Lake City, Utah, United States

Site Status

Countries

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United States

Other Identifiers

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U01DK138901

Identifier Type: NIH

Identifier Source: secondary_id

View Link

15225

Identifier Type: -

Identifier Source: org_study_id