Center for Inflammatory Bowel Disease, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA.
Division of Gastroenterology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA.
Gastrointest Endosc. 2019 Aug;90(2):186-195.e1. doi: 10.1016/j.gie.2019.04.219. Epub 2019 Apr 19.
Patients with ulcerative colitis have an increased risk of colorectal cancer. We sought to assess the comparative efficacy of standard white-light endoscopy (SDWLE) or high-definition white-light endoscopy (HDWLE) versus dye-based chromoendoscopy through a meta-analysis and rate the quality of evidence using the GRADE (Grading of Recommendations Assessment, Development, and Evaluation) system.
A systematic review of the literature in PubMed, EMBASE, and Web of Science was performed in April 2018. The primary outcome was the number of patients in whom dysplasia was identified using a per patient analysis in randomized controlled trials (RCT) and analyzed separately for non-RCTs. Analysis was performed using RevMan 5.3 reporting random-effects risk ratios.
Of the 27,904 studies identified, 10 studies were included 6 of which were RCTs (3 SDWLE and 3 HDWLE). Seventeen percent (84/494) of patients were noted to have dysplasia using chromoendoscopy compared with 11% (55/496) with white-light endoscopy (relative risk [RR] 1.50; 95% confidence interval [CI], 1.08-2.10). When analyzed separately, chromoendoscopy (n = 249) was more effective at identifying dysplasia than SDWLE (n = 248) (RR, 2.12; 95% CI, 1.15-3.91), but chromoendoscopy (n = 245) was not more effective compared with HDWLE (n = 248) (RR, 1.36; 95% CI, 0.84-2.18). The quality of evidence was moderate. In non-RCTs, dysplasia was identified in 16% (114/698) of patients with chromoendoscopy compared with 6% (62/1069) with white-light endoscopy (RR, 3.41; 95% CI, 2.13-5.47). Chromoendoscopy (n = 58) was more effective than SDWLE (n = 141) for identification of dysplasia (RR, 3.52; 95% CI, 1.38-8.99), and chromoendoscopy (n = 113) was also more effective than HDWLE (n = 257) (RR, 3.15; 95% CI, 1.62-6.13). The quality of the evidence was very low.
Based on this meta-analysis, non-RCTs demonstrate a benefit of chromoendoscopy over SDWLE and HDWLE, whereas RCTs only show a small benefit of chromoendoscopy over SDWLE, but not over HDWLE.
溃疡性结肠炎患者结直肠癌风险增加。我们旨在通过荟萃分析评估标准白光内镜（SDWLE）或高清白光内镜（HDWLE）与基于染料的染色内镜相比的比较疗效，并使用 GRADE（推荐评估、制定与评价）系统对证据质量进行评级。
2018 年 4 月在 PubMed、EMBASE 和 Web of Science 中进行了文献系统综述。主要结局是在随机对照试验（RCT）中对每个患者进行分析时，使用染色内镜发现的患者数量，并分别对非 RCT 进行分析。分析使用 RevMan 5.3 报告随机效应风险比。
在 27904 项研究中，有 10 项研究被纳入，其中 6 项为 RCT（3 项 SDWLE 和 3 项 HDWLE）。使用染色内镜发现的患者中有 17%（84/494）存在异型增生，而使用白光内镜发现的患者中有 11%（55/496）（相对风险 [RR] 1.50；95%置信区间 [CI]，1.08-2.10）。单独分析时，染色内镜（n=249）比 SDWLE（n=248）更有效地识别异型增生（RR，2.12；95%CI，1.15-3.91），但染色内镜（n=245）与 HDWLE（n=248）相比并没有更有效（RR，1.36；95%CI，0.84-2.18）。证据质量为中等。在非 RCT 中，染色内镜（n=698）发现异型增生的患者占 16%（114/698），而白光内镜（n=1069）发现异型增生的患者占 6%（62/1069）（RR，3.41；95%CI，2.13-5.47）。染色内镜（n=58）比 SDWLE（n=141）更有效地识别异型增生（RR，3.52；95%CI，1.38-8.99），而染色内镜（n=113）也比 HDWLE（n=257）更有效（RR，3.15；95%CI，1.62-6.13）。证据质量极低。
基于这项荟萃分析，非 RCT 显示染色内镜优于 SDWLE 和 HDWLE，而 RCT 仅显示染色内镜略优于 SDWLE，但不如 HDWLE。
