1. Dye Chromoendoscopy Outperforms High-Definition White Light Endoscopy in Dysplasia Detection for Patients With Inflammatory Bowel Disease: An Updated Meta-Analysis of Randomized Controlled Trials.
- Author
-
Mohamed, Mouhand F. H., Marino, Daniel, Elfert, Khaled, Beran, Azizullah, Nayfeh, Tarek, Abdallah, Mohamed A., Sultan, Shahnaz, and Shah, Samir A.
- Subjects
- *
INFLAMMATORY bowel diseases , *RANDOMIZED controlled trials , *VIRTUAL colonoscopy , *DYSPLASIA , *CONTRAST-enhanced magnetic resonance imaging , *ENDOSCOPY - Abstract
INTRODUCTION: Whether dye spray chromoendoscopy (DCE) adds value in surveillance colonoscopy with high-definition (HD) scopes remains controversial. This updated meta-analysis compares dysplasia detection using DCE and high-definition white light endoscopy (HD-WLE) in patients with inflammatory bowel disease (IBD) undergoing surveillance colonoscopy. METHODS: A comprehensive search was performed for randomized controlled trials (RCT) comparing HD-WLE and DCE in patients with IBD. The primary outcome was to compare the proportion of patients with at least 1 dysplastic lesion detected by DCE vs HD-WLE. Odds ratios (OR) and95%confidence intervals (CI) were pooled using the random-effects model, with I² > 60% indicating substantial heterogeneity. The Grading of Recommendations, Assessment, Development, and Evaluation approach was used to assess the certainty of evidence (CoE). RESULTS: Six RCT involving 978 patients were analyzed (DCE5479 vs HD-WLE5499 patients). DCE detected significantlymore patients with dysplasia thanHD-WLE (18.8%vs9.4%), OR1.94 (95%CI1.21-3.11, I²=28%, P50.006, highCoE). This remained significant after excluding2 RCTpublished as abstracts. A sensitivity analysis excluding a noninferiority RCT with a single experienced operator eliminated the results' heterogeneity, OR 2.46 (95%CI 1.56-3.90, I²=0%). Although high-grade dysplasia detection was numerically higher in the DCE group (2.8% vs 1.1%), the difference was statistically insignificant, OR 2.21 (95% CI 0.64-7.62, I² = 0%, low CoE). DISCUSSION: Our updated meta-analysis supports DCE as a superior strategy in overall dysplasia detection in IBD, even with HD scopes. When expertise is available, DCE should be considered for surveillance colonoscopy in patients with high-risk IBD, with the acknowledgment that virtual chromoendoscopy shows equivalence in recent studies. Further multicenter trials with multiple endoscopists with varying expertise levels and longer-term outcome data showing a reduction in cancer or cancer-related death are needed. [ABSTRACT FROM AUTHOR]
- Published
- 2024
- Full Text
- View/download PDF