Meta-analysis of Virtual-based Chromoendoscopy Compared With Dye-spraying Chromoendoscopy Standard and High-definition White Light Endoscopy in Patients With Inflammatory Bowel Disease at Increased Risk of Colon Cancer

Abstract

Background Patients with inflammatory bowel disease (IBD) have an increased risk of colorectal cancer. We sought to assess the comparative efficacy of virtual chromoendoscopy (VCE) vs high definition white light endoscopy (HDWLE) or dye-spraying chromoendoscopy (DCE) through a meta-analysis and rating the quality of evidence. Methods A systematic review of the literature was performed through February 15, 2019. Primary outcomes were number of patients in whom dysplasia was identified and number of dysplastic lesions identified in these patients. We included only randomized control trials (RCTs) and performed meta-analysis using RevMan5.3. Results Of the 3205 studies identified, 11 RCTs were included, with a total of 1328 patients. Per patient analysis, VCE was not statistically different compared with DCE (risk ratio [RR] 0.77; 95% CI, 0.55–1.08) or HDWLE (RR 0.72; 95% CI, 0.45–1.15). However, per dysplasia analysis, VCE was not statistically different compared with DCE (RR 0.72; 95% CI, 0.47–1.11) and inferior compared with HDWLE (RR 0.62; 95% CI, 0.44–0.88). The quality of evidence was moderate in the HDWLE and low to moderate in the DCE studies. Conclusion Based on this meta-analysis, VCE was as good as HDWLE and DCE in identifying dysplasia per patient analysis. However, per dysplasia analysis, VCE was inferior compared with HDWLE and no different from DCE. Further studies need to examine the efficacy of each individual VCE technique.

AGA Clinical Practice Update on Endoscopic Surveillance and Management of Colorectal Dysplasia in Inflammatory Bowel Diseases: Expert Review

“…35 Early studies generally failed to show a benefit of VCE technologies for dysplasia detection with either standarddefinition or HD endoscopes in patients with cIBD. [36][37][38][39][40][41] However, several recent studies have shown similar dysplasia detection rates when comparing HD NBI with DCE 39,42,43 or HD iscan with DCE, 36,39 with shorter withdrawal times favoring VCE methods. A recent meta-analysis of 11 RCTs confirmed that VCE performed similarly to DCE and HD-WLE with respect to dysplasia detection on a perpatient basis.…”

“…A recent meta-analysis of 11 RCTs confirmed that VCE performed similarly to DCE and HD-WLE with respect to dysplasia detection on a perpatient basis. 39 Best Practice Advice 8: Extensive nontargeted biopsies (roughly 4 adequately spaced biopsies every 10 cm) should be taken from flat colorectal mucosa in areas previously affected by colitis when white light endoscopy is used without dye spray chromoendoscopy or virtual chromoendoscopy. Additional biopsies should be taken from areas of prior dysplasia or poor mucosal visibility.…”

Practice pattern variability among gastroenterologists in colorectal cancer surveillance and management of colorectal dysplasia in inflammatory bowel disease

“…This is also reflected in their preference of surveillance modality, in which HDWLE with VCE ranked second. A recent meta‐analysis 32 revealed that virtual‐based chromoendoscopy was as good as HDWLE and dye‐spraying chromoendoscopy in identifying dysplasia per patient analysis. In addition, with the advantages of a shorter procedure time and overall the lower cost of the procedure resulting from avoiding methylene blue or indigo carmine and performing biopsies, VCE may assume a more important role in CRC surveillance in IBD in the future.…”

Artificial intelligence in inflammatory bowel disease endoscopy: current landscape and the road ahead

“…When looking at per patient analysis, there were no statistical differences between VCE, traditional chromoendoscopy, and HD-WLE. 26 Although still being investigated, VCE could be an additional modality that could be used by AI systems to target dysplasia in IBD.…”