HELIOS: HD-WLE can yield similar neoplasia detection rates as HD-CE

High-definition white light endoscopy with segmental re-inspection (HD-WLE with SR) was non-inferior to dye-based high-definition chromoendoscopy (HD-CE) for the detection of colorectal neoplasia in patients with inflammatory bowel disease (IBD) in the HELIOS trial.

“Although dye-based HD-CE is considered the gold standard for detecting colorectal neoplasia in patients with IBD, the uptake remains fairly low in clinical practice, likely due to issues of practicality, cost, and training,” said Dr Maarten te Groen (Radboudumc, the Netherlands) [1]. “Therefore, HD-WLE is more frequently used in clinical practice.” He explained that it remains unknown whether the advantage of HD-CE comes from enhanced contrast or from longer withdrawal times. Evidence in the non-IBD population indicates that longer withdrawal times are correlated with higher colorectal neoplasia detection rates [2]. “We hypothesised that HD-WLE with matched withdrawal times may yield similar neoplasia detection rates as HD-CE,” Dr te Groen expressed [1].

The randomised-controlled HELIOS trial (NCT04291976) compared 3 endoscopy techniques for the outcome measure of colorectal neoplasia in patients with IBD. HD-WLE with SR was tested against HD-CE for non-inferiority and compared with single-pass HD-WLE for superiority. The trial randomised 666 adult patients with IBD who were scheduled for endoscopic surveillance 2:2:1 to HD-WLE with SR, HD-CE, or single-pass HD-WLE.

The colorectal neoplasia detection rate was 10.3% in the HD-WLE with SR arm and 13.1% in the HD-CE arm. The lower bound of the 95% confidence interval (-7.8%) did not cross the non-inferiority border of -10.0%; therefore, non-inferiority of HD-WLE with SR to HD-CE was demonstrated in this population (P_{non-inferiority}<0.01). The colorectal neoplasia detection rate was 6.1% in the single-pass HD-WLE arm; the difference of 4.1% with the HD-WLE with SR arm was not statistically significant (95% CI -2.2 to 9.6%; P=0.19). Finally, the median withdrawal times were 19, 26, and 15 minutes in the HD-WLE with SR, HD-CE, and single-pass HD-WLE arms, respectively.

“HD-WLE with SR is non-inferior to HD-CE but not superior to single-pass HD-WLE,” concluded Dr te Groen. He argued that the lower-than-expected colorectal neoplasia rates and subsequent lower power of the trial could be an explanation for the result of the superiority analysis. “Also, the results indicate that the benefit from HD-CE is mostly explained by the longer withdrawal time and not necessarily by enhanced contrast.”

1. Te Groen M, et al. High-definition white light endoscopy with segmental re-inspection is non-inferior to dye-based chromoendoscopy in inflammatory bowel disease: the randomized controlled HELIOS trial. OP15, 19^th Congress of ECCO, 21–24 February 2024, Stockholm, Sweden.
2. Shaukat A, et al. Gastroenterology. 2015;149(4):952-957.

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Posted on 18 April, 202418 April, 2024