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.

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 .