Endoscopic Techniques for Colorectal Neoplasia Surveillance in Inflammatory Bowel Disease: A Systematic Review and Network Meta-Analysis.

Abstract

Background and aims: Dye-based chromoendoscopy (DCE) has been the preferred method for colonoscopy surveillance in patients with inflammatory bowel disease (IBD). However, with advances in endoscopy, virtual chromoendoscopy (VCE) techniques have emerged. This network meta-analysis evaluates the effectiveness of different endoscopy techniques for IBD patient surveillance.

Methods: Sixteen randomized controlled trials involving 2514 patients were included in the analysis, comparing endoscopy techniques in IBD patient surveillance: DCE, high-definition white light endoscopy (WLE), standard-definition WLE, i-scan, narrow band imaging (NBI), flexible spectral imaging color enhancement (FICE), and autofluorescence imaging (AFI). We assessed the per patient neoplasia detection rate, positive predictive value (PPV), and withdrawal time between different endoscopy techniques. Moreover, subgroup analysis was conducted to investigate the neoplasia detection rate according to endoscopy techniques using various biopsy protocols.

Results: Comparing neoplasia detection rates revealed that only DCE (OR: 2.56 [1.17-5.59]) significantly increased the neoplasia detection rate compared with standard-definition WLE. The subsequent rankings were high-definition WLE, NBI, FICE, i-scan, and AFI. Moreover, the PPVs of DCE, VCE, and high-definition WLE showed no significant difference compared with that of standard-definition WLE. However, DCE required a significantly longer withdrawal time. Subgroup analysis showed that DCE with random biopsy or target biopsy and high-definition WLE with target biopsy had superior neoplasia detection rates than standard-definition WLE with random biopsy.

Conclusion: DCE significantly outperforms standard-definition WLE in neoplasia detection rates, with random biopsy providing additional benefits. Although DCE does not lower PPV, it requires more withdrawal time. If DCE-based surveillance is not feasible, high-definition WLE with targeted biopsy should be considered as other VCE techniques offer no significant advantages.