Linked color imaging white light imaging in the diagnosis of colorectal lesions: a meta-analysis of randomized controlled trials.

BACKGROUND

Miss rate of colorectal neoplasia is associated with lesion histology, size, morphology, or location.

OBJECTIVES

We aim to compare the efficacy of Linked color imaging (LCI) white light imaging (WLI) for adenoma detection rate (ADR), the detection of sessile serrated lesions (SSLs), serrated lesions (SLs), advanced adenomas (AAs), diminutive lesions (DLs), and flat lesions (FLs) by using per-patient and per-lesion analysis based on randomized controlled trials (RCTs).

DESIGN

Systematic review and meta-analysis.

DATA SOURCES AND METHODS

PubMed, Embase, and Cochrane databases were searched through May 1st, 2023. We calculated risk ratio for dichotomous outcomes and mean difference for continuous outcomes, and performed sensitivity analyses and subgroup analyses.

RESULTS

Overall, 17 RCTs (10,624 patients) were included. In per-patient analysis, ADR was higher in the LCI group the WLI group ( < 0.00001). This effect was consistent for SSL ( = 0.005), SLs ( = 0.01), AAs ( = 0.04), DLs ( < 0.00001), and FLs ( < 0.0001). In per-lesion analysis, LCI showed a significant superiority over WLI with regard to the mean number of adenomas per patient ( < 0.00001). This effect was in accordance with mean SSL ( = 0.001), mean SLs ( < 0.00001), and mean DLs ( < 0.0001) per patient. A subgroup analysis showed that the beneficial effect of the LCI group on the detection of AAs, SSL, and FLs was maintained only for studies when experts and trainees were included but not for experts only.

CONCLUSIONS

Meta-analyses of RCTs data support the use of LCI in clinical practice, especially for trainees.