Gastroenterology, Department of Clinical Medicine and Surgery, School of Medicine 'Federico II' of Naples, Naples, Italy.
Surgical Endoscopy, Department of Clinical Medicine and Surgery, School of Medicine 'Federico II' of Naples, Naples, Italy.
J Crohns Colitis. 2019 May 27;13(6):714-724. doi: 10.1093/ecco-jcc/jjy218.
Considering the high risk of dysplasia and cancer in inflammatory bowel disease [IBD], surveillance is advocated. However, international guidelines do not reach a uniform recommendation on the way to perform surveillance. We performed a systematic review with a meta-analysis to assess the best endoscopic surveillance strategy in colonic IBD.
The systematic review was performed in PubMed/MEDLINE, EMBASE, SCOPUS, and Cochrane databases to identify studies comparing white light endoscopy [WLE] and augmented endoscopy [AE] in the detection of dysplasia/neoplasia in colonic IBD. A sub-analysis between dye-spray chromoendoscopy [DCE], narrow-band imaging [NBI], I-SCAN, full-spectrum endoscopy [FUSE], and auto-fluorescence imaging [AFI] was also performed. Furthermore, a meta-regression and a network meta-analysis were also performed.
A total of 27 studies [6167 IBD patients with 2024 dysplastic lesions] met the inclusion criteria. There was no publication bias. AE showed a higher likelihood of detecting dysplasia than WLE (19.3% vs 8.5%, odds ratio [OR] = 2.036), with an incremental yield [IY] of 10.8%. DCE [OR = 2.605] and AFI [OR = 3.055] had higher likelihood of detecting dysplasia than WLE; otherwise, I-SCAN [OR = 1.096], NBI [OR = 0.650], and FUSE [OR = 1.118] were not superior to WLE. Dysplasia was found in 1256/7267 targeted biopsies [17.3%] and in 363/110 040 random biopsies [0.33%] [OR = 66.559, IY = 16.9%]. Meta-regression found no variable impacting on the efficacy of AE techniques. Network meta-analysis identified a significant superiority of DCE to WLE in detecting dysplasia [OR 2.12], but no other single technique was found to be superior to all others in dysplasia detection.
DCE was associated with higher likelihood of discovering dysplastic lesions than WLE. Chromoendoscopy is the best supported endoscopic technique for IBD surveillance.
鉴于炎症性肠病（IBD）中发育不良和癌症的高风险，建议进行监测。然而，国际指南并未就监测方式达成一致建议。我们进行了一项系统评价和荟萃分析，以评估结直肠 IBD 最佳的内镜监测策略。
在 PubMed/MEDLINE、EMBASE、SCOPUS 和 Cochrane 数据库中进行系统评价，以确定比较白光内镜（WLE）和增强内镜（AE）在检测结直肠 IBD 中发育不良/肿瘤的研究。还进行了染色喷雾 chromoendoscopy [DCE]、窄带成像 [NBI]、I-SCAN、全光谱内镜 [FUSE] 和自体荧光成像 [AFI] 之间的亚分析。此外，还进行了 meta 回归和网络荟萃分析。
共有 27 项研究[6167 例 IBD 患者，2024 例有发育不良病变]符合纳入标准。没有发表偏倚。AE 检测到发育不良的可能性高于 WLE（19.3%比 8.5%，比值比 [OR] = 2.036），增量收益 [IY] 为 10.8%。DCE [OR = 2.605]和 AFI [OR = 3.055] 检测到发育不良的可能性高于 WLE；而 I-SCAN [OR = 1.096]、NBI [OR = 0.650] 和 FUSE [OR = 1.118] 并不优于 WLE。在 7267 例靶向活检中发现了 1256 例发育不良[17.3%]，在 110040 例随机活检中发现了 363 例发育不良[0.33%] [OR = 66.559，IY = 16.9%]。元回归发现没有变量影响 AE 技术的疗效。网络荟萃分析发现 DCE 检测到发育不良的可能性明显高于 WLE[OR 2.12]，但没有发现任何单一技术在检测发育不良方面优于其他技术。
DCE 发现发育不良病变的可能性高于 WLE。染色内镜是 IBD 监测的最佳内镜技术。
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