Comparison of Endoscopic Dysplasia Detection Techniques in Patients With Ulcerative Colitis: A Systematic Review and Network Meta-analysis.

Abstract

We assessed the comparative efficacy of different dysplasia detection techniques in patients with ulcerative colitis (UC) through a network meta-analysis and rated the quality of evidence using GRADE approach. Through a systematic literature review of multiple databases through June 30, 2017, we identified parallel-group randomized controlled trials (RCTs) in adults with long-standing UC undergoing surveillance colonoscopy with standard definition-white light endoscopy (SD-WLE), high-definition WLE (HD-WLE), narrow band imaging (NBI), or dye-based chromoendoscopy. The primary outcome was the total number of dysplastic lesions. Pairwise and network meta-analysis was performed; ranking was assessed using surface under the cumulative ranking (SUCRA) probabilities. Based on 8 parallel-group RCTs (924 patients), low-quality evidence supports chromoendoscopy over SD-WLE (odds ratio [OR], 2.37; 95% credible interval [CrI], 0.81-6.94) for any dysplasia detection, whereas very low-quality evidence supports using HD-WLE or NBI over SD-WLE (HD-WLE [vs SD-WLE]: OR, 1.21; 95% CrI, 0.30-4.85; NBI: OR, 1.68; 95% CrI, 0.54-5.22). Very low-quality evidence from indirect comparative analysis supports the use of chromoendoscopy over HD-WLE (OR, 1.96; 95% CrI, 0.72-5.34) or NBI (OR, 1.41; 95% CrI, 0.70-2.84) for any dysplasia detection. The number of patients with advanced neoplasia was very small, precluding meaningful analysis. Although we did not find any single technique to be superior, chromoendoscopy is probably more effective than SD-WLE for detecting any dysplasia, and there is low confidence in estimates supporting its use over HD-WLE or NBI. There is very low-quality evidence to inform the comparative efficacy of these interventions in detecting advanced neoplasia or preventing future colorectal cancer. Pragmatic, parallel-group RCTs with longitudinal follow-up are warranted to inform optimal dysplasia surveillance techniques. 10.1093/ibd/izy188_video1izy188.video15789702674001.