Meta-analysis of dye-based chromoendoscopy compared with standard- and high-definition white-light endoscopy in patients with inflammatory bowel disease at increased risk of colon cancer

Abstract

Background: Patients with ulcerative colitis have an increased risk of colorectal cancer. We sought to assess the comparative efficacy of standard white-light endoscopy (SDWLE) or high-definition white-light endoscopy (HDWLE) versus dye-based chromoendoscopy through a meta-analysis and rate the quality of evidence using the GRADE (Grading of Recommendations Assessment, Development, and Evaluation) system. Methods: A systematic review of the literature in PubMed, EMBASE, and Web of Science was performed in April 2018. The primary outcome was the number of patients in whom dysplasia was identified using a per patient analysis in randomized controlled trials (RCT) and analyzed separately for non-RCTs. Analysis was performed using RevMan 5.3 reporting random-effects risk ratios. Results: Of the 27,904 studies identified, 10 studies were included 6 of which were RCTs (3 SDWLE and 3 HDWLE). Seventeen percent (84/494) of patients were noted to have dysplasia using chromoendoscopy compared with 11% (55/496) with white-light endoscopy (relative risk [RR] 1.50; 95% confidence interval [CI], 1.08-2.10). When analyzed separately, chromoendoscopy (n Z 249) was more effective at identifying dysplasia than SDWLE (n Z 248) (RR, 2.12; 95% CI, 1.15-3.91), but chromoendoscopy (n Z 245) was not more effective compared with HDWLE (n Z 248) (RR, 1.36; 95% CI, 0.84-2.18). The quality of evidence was moderate. In non-RCTs, dysplasia was identified in 16% (114/698) of patients with chromoendoscopy compared with 6% (62/1069) with white-light endoscopy (RR, 3.41; 95% CI, 2.13-5.47). Chromoendoscopy (n Z 58) was more effective than SDWLE (n Z 141) for identification of dysplasia (RR, 3.52; 95% CI, 1.38-8.99), and chromoendoscopy (n Z 113) was also more effective than HDWLE (n Z 257) (RR, 3.15; 95% CI, 1.62-6.13). The quality of the evidence was very low. Conclusion: Based on this meta-analysis, non-RCTs demonstrate a benefit of chromoendoscopy over SDWLE and HDWLE, whereas RCTs only show a small benefit of chromoendoscopy over SDWLE, but not over HDWLE.

High-Definition Chromoendoscopy Superior to High-Definition White-Light Endoscopy in Surveillance of Inflammatory Bowel Diseases in a Randomized Trial

“…(5) .027 Patients with advanced adenoma, n (%) 6 (4) 3 (2) .305 6 (5) 3 (2) .314 Patients with dysplasia in random biopsies, n (%) 6 (4) 3 (2) .305 6 (5) 3 (2) .479 Patients with all types of dysplasia, n (%) 21 (14) 9 (6) .020 19 (14) 8 (6) .027 Colorectal cancer 0 0 NA 0 0 NA Macroscopic lesions/10 min of withdrawal time, n 0 Previous research found that CE was superior to WLE in the detection of dysplasia in IBD when using standard resolution endoscopes. 6,7 Our results support that this is also the case when using HD endoscopes. In 2 recent meta-analysis 6,7 that included 3 randomized controlled studies, [12][13][14][15] HD-CE was compared with HD-WLE in subgroup analysis.…”

“…[3][4][5] Two recent meta-analysis reported a higher likelihood of detecting patients with dysplasia with CE as compared with white light endoscopy (WLE), but subgroup analyses confirmed this finding only when CE was compared with standard-definition WLE. 6,7 Thus, the evidence in support of CE using high-definition (HD) endoscopes is weak.…”

Chromoendoscopy meta-analysis: correcting subgroup analysis interpretation

“…Rather, subgroup analyses focus on the difference in the effect of the intervention between the subgroups: eg, is the increase in detection of dysplasia with chromoendoscopy versus SDWLE significantly different from the increase with chromoendoscopy versus HDWLE? [2][3][4] In the study by Feuerstein et al, 1 the test for subgroup difference P value was 0.26. Therefore, the detection of dysplasia with chromoendoscopy versus SDWLE is not significantly different from the detection with chromoendoscopy versus HDWLE.…”

“…We appreciate the interest and comments from Laine et al, 1 but we would like to highlight that none of our results were a subgroup analysis 1. In the methods, we noted that we performed a primary analysis comparing standard-definition white-light endoscopy (SDWLE) with chromoendoscopy and high-definition white-light endoscopy (HDWLE) with chromoendoscopy 2.…”

How do we survey IBD in Japan: chromoendoscopy versus white light?

“…A recent meta-analysis of 10 studies (494 patients) compared dye-based chromoendoscopy with standard-definition WLE and high-definition WLE 7 . RCTs in the literature showed a small benefit of chromoendoscopy over standard-definition WLE, but not over high-definition WLE.…”