Abstract
Abstract Background Patients with inflammatory bowel disease (IBD) have increased risk of colorectal cancer than the general population, making colonoscopy surveillance for neoplastic lesions critically significant. Dye-based chromoendoscopy (DCE) has traditionally been considered the preferred image enhanced endoscopy for colonoscopy surveillance. However, clinical adherence to DCE is low, with white light endoscopy (WLE) frequently used for surveillance instead. With advancements in endoscopy, various virtual chromoendoscopy (VCE) techniques have emerged as alternatives for colonoscopy surveillance. Therefore, this network meta-analysis aimed to investigate the superior endoscopy techniques for IBD patient surveillance. Methods Sixteen randomized controlled trials involving 2,514 patients were included in the analysis, comparing different endoscopy techniques in IBD patient colonoscopy surveillance: DCE, high-definition WLE (HD-WLE), standard-definition WLE (SD-WLE), i-scan, NBI, flexible spectral imaging color enhancement (FICE), and AFI. We assessed the per patient neoplasia detection rate (NDR), positive predictive value (PPV), and withdrawal time between different endoscopy techniques. Subgroup analysis was conducted to compare the NDR of DCE, VCE, and HD-WLE with either target or random biopsy protocols. Results Comparing NDRs revealed that only DCE (odds ratio [OR]: 2.56 [95% confidence interval [CI]: 1.17–5.59]) significantly increased the NDR compared with SD-WLE. The subsequent rankings were HD-WLE, NBI, FICE, i-scan, and AFI. Moreover, the PPVs of DCE, VCE, and HD-WLE showed no significant difference compared with that of SD-WLE. However, DCE required a significantly longer withdrawal time. Subgroup analysis showed that DCE with random biopsy (OR: 4.42 [95% CI: 2.26–8.65]) or target biopsy (OR: 2.01 [95% CI: 1.12–3.61]) and HD-WLE with target biopsy (OR: 3.33 [95% CI: 1.51–7.31]) had superior NDRs than SD-WLE with random biopsy. Conclusion DCE has a significant advantage over SD-WLE in NDRs, where random biopsy may offer substantial benefits. While, DCE has similar PPVs compared with other techniques, it requires more withdrawal time. If performing DCE for surveillance colonoscopy is challenging, using HD-WLE with target biopsy also shows a trend of benefit, while other VCE techniques do not offer significant advantages.
Published Version
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