CC BY-NC-ND 4.0 · Endosc Int Open 2020; 08(05): E578-E590
DOI: 10.1055/a-1120-8376
Review

Surveillance in inflammatory bowel disease: is chromoendoscopy the only way to go? A systematic review and meta-analysis of randomized clinical trials

Ricardo Hannum Resende
1  Department of Endoscopy of Clinics Hospital of São Paulo University, São Paulo, Brazil
,
Igor Braga Ribeiro
1  Department of Endoscopy of Clinics Hospital of São Paulo University, São Paulo, Brazil
,
Diogo Turiani Hourneaux de Moura
1  Department of Endoscopy of Clinics Hospital of São Paulo University, São Paulo, Brazil
2  Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, United States
,
Facundo Galetti
1  Department of Endoscopy of Clinics Hospital of São Paulo University, São Paulo, Brazil
,
Rodrigo Silva de Paula Rocha
1  Department of Endoscopy of Clinics Hospital of São Paulo University, São Paulo, Brazil
,
Wanderley Marques Bernardo
1  Department of Endoscopy of Clinics Hospital of São Paulo University, São Paulo, Brazil
,
Paulo Sakai
1  Department of Endoscopy of Clinics Hospital of São Paulo University, São Paulo, Brazil
,
Eduardo Guimarães Hourneaux de Moura
1  Department of Endoscopy of Clinics Hospital of São Paulo University, São Paulo, Brazil
› Author Affiliations
  

Abstract

Background and study aims Ulcerative colitis (UC) and Crohn’s disease (CD) have higher risk of colorectal cancer (CRC). Guidelines recommend dysplasia surveillance with dye-spraying chromoendoscopy (DCE). The aim of this systematic review and meta-analysis was to review all randomized clinical trials (RCTs) available and compare the efficacy of different endoscopic methods of surveillance for dysplasia in patients with UC and CD.

Methods Databases searched were Medline, EMBASE, Cochrane and SCIELO/LILACS. It was estimated the risk difference (RD) for dichotomous outcomes (number of patients diagnosed with one or more dysplastic lesions, total number of dysplastic lesions diagnosed and number of dysplastic lesions detected by targeted biopsies) and mean difference for continuous outcomes (procedure time).

Results This study included 17 RCTs totaling 2,457 patients. There was superiority of DCE when compared to standard-definiton white light endoscopy (SD-WLE). When compared with high-definition (HD) WLE, no difference was observed in all outcomes (number of patients with dysplasia (RD 0.06; 95 % CI [–0.01, 0.13])). Comparing other techniques, no difference was observed between DCE and virtual chromoendoscopy (VCE – including narrow-band imaging [NBI], i-SCAN and flexible spectral imaging color enhancement), in all outcomes except procedure time (mean difference, 6.33 min; 95 % CI, 1.29, 11.33). DCE required a significantly longer procedure time compared with WLE (mean difference, 7.81 min; 95 % CI, 2.76, 12.86).

Conclusions We found that dye-spraying chromoendoscopy detected more patients and dysplastic lesions than SD-WLE. Although no difference was observed between DCE and HD-WLE or narrow-band imaging, the main outcomes favored numerically dye-spraying chromoendoscopy, except procedure time. Regarding i-SCAN, FICE and auto-fluorescence imaging, there is still not enough evidence to support or not their recommendation.

Supplementary material



Publication History

Received: 25 September 2019

Accepted: 04 February 2020

Publication Date:
17 April 2020 (online)

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