Section of Gastroenterology, University of Bari, Bari, Italy.
Diaverum Medical Scientific Office, Lund, Sweden; Department of Translational Medicine, Amedeo Avogadro University of Eastern Piedmont, Novara, Italy.
Clin Gastroenterol Hepatol. 2017 Nov;15(11):1684-1697.e11. doi: 10.1016/j.cgh.2016.11.021. Epub 2016 Nov 25.
BACKGROUND & AIMS: Key international guideline agencies recommend dysplasia surveillance in inflammatory bowel diseases with chromoendoscopy. We performed a systematic review of randomized trials comparing chromoendoscopy vs other endoscopic techniques for dysplasia surveillance in inflammatory bowel diseases.
We searched MEDLINE, EMBASE, and the Cochrane Central Register of Controlled Trials for relevant studies published through September 2016. We estimated risk ratios (RRs) for dichotomous outcomes (all-cause/colorectal cancer-related mortality, time to interval cancer, patients with dysplasia, total/subtypes of dysplastic lesions, dysplasia detected by targeted biopsies, adverse events), mean differences for continuous outcomes (procedural time, costs, total/targeted biopsies), and their 95% confidence intervals (CIs) using a random-effects model. Subgroup analyses included technique compared with chromoendoscopy, type of disease, and type of dye. We estimated sensitivity and specificity of the techniques with reference to histology.
We identified 10 randomized trials (n = 1500 participants). There was a higher likelihood of detecting patients with dysplasia with chromoendoscopy compared with other techniques (RR, 1.37; 95% CI, 1.04-1.79). Subgroup analyses confirmed this effect only if chromoendoscopy was compared with standard-definition white-light endoscopy (RR, 2.12; 95% CI, 1.15-3.91). Chromoendoscopy required a significantly longer procedural time compared with other techniques (mean difference, 8.91 min; 95% CI, 1.37-16.45). There was no difference in the likelihood of detecting dysplastic subtypes and dysplasia by targeted biopsies between groups. Test sensitivity and specificity were similar between groups.
In surveillance of inflammatory bowel diseases, chromoendoscopy identifies more patients with dysplasia only when compared with standard-definition white-light endoscopy. It is associated with longer procedural time with no direct evidence of effect on preventing all-cause/cancer-specific mortality or time to interval cancer.
关键的国际指南机构建议对炎症性肠病进行色素内镜监测以发现异型增生。我们对比较炎症性肠病异型增生监测的色素内镜与其他内镜技术的随机试验进行了系统评价。
我们检索了 MEDLINE、EMBASE 和 Cochrane 对照试验中心注册库，以获取截至 2016 年 9 月发表的相关研究。我们使用随机效应模型估算了二分类结局（全因/结直肠癌相关死亡率、间期癌发生时间、异型增生患者、异型增生总病变/亚型、靶向活检检出的异型增生、不良事件）的风险比（RR）、连续结局（操作时间、费用、总/靶向活检）的均数差值及其 95%置信区间（CI）。亚组分析包括与色素内镜比较的技术、疾病类型和染料类型。我们参照组织学，估算了这些技术的敏感性和特异性。
我们共确定了 10 项随机试验（n=1500 例参与者）。与其他技术相比，色素内镜更有可能发现异型增生患者（RR，1.37；95%CI，1.04-1.79）。亚组分析证实，仅当将色素内镜与标准清晰度白光内镜进行比较时，才会出现这种效果（RR，2.12；95%CI，1.15-3.91）。与其他技术相比，色素内镜的操作时间明显更长（平均差值，8.91 分钟；95%CI，1.37-16.45）。两组间在靶向活检检出异型增生亚型和异型增生的可能性方面无差异。组间检测的敏感性和特异性相似。
在炎症性肠病的监测中，仅当与标准清晰度白光内镜相比时，色素内镜才能更有效地发现异型增生患者。它与较长的操作时间相关，但没有直接证据表明其可以预防全因/癌症特异性死亡率或间期癌发生时间。
