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

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. 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. 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. 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. ISRCTN, ISRCTN10174296. Registered 9 March 2026, https://www.isrctn.com/ISRCTN10174296.