Sinopoulou Vasiliki, Nigam Gaurav B, Gordon Morris, Ganeshan Meghana, Tokonyai Mitchell Rudo, Dolwani Sunil, Iacucci Marietta, Rutter Matt, Subramanian Venkat, Wilson Ana, East James E
University of Central Lancashire, School of Medicine, Preston, Lancashire, United Kingdom.
Translational Gastroenterology Unit, Nuffield Department of Medicine, John Radcliffe Hospital, University of Oxford, Oxford, United Kingdom.
Clin Gastroenterol Hepatol. 2024 Dec 13. doi: 10.1016/j.cgh.2024.11.008.
BACKGROUND & AIMS: Long-standing inflammatory bowel disease (IBD) increases the risk of colonic neoplasia, necessitating effective screening strategies. This network meta-analysis compared the efficacy and safety between different endoscopic modalities in the high-definition (HD) era.
We searched CENTRAL, ClinicalTrials.gov, Embase, MEDLINE, and WHO for randomized controlled trials (RCTs) comparing endoscopic modalities for screening colonoscopy in patients with IBD up to February 2024. The primary outcome was detection of any dysplastic lesion per patient. The certainty of the evidence was GRADE-assessed.
A total of 26 RCTs involving 4159 participants were included, comparing 6 endoscopic modalities: HD white light endoscopy (HD-WLE), HD virtual chromoendoscopy (HD-VCE), HD dye-based chromoendoscopy (HD-DCE), HD-WLE with segmental re-inspection (SR), auto-fluorescence imaging (AFI), and full-spectrum endoscopy (FUSE). HD-DCE may have a small benefit in detecting dysplasia over HD-WLE (low certainty, small magnitude;: relative risk [RR], 1.42; 95% confidence interval [CI], 1.02-1.98). FUSE may be no different to HD-WLE (low certainty: RR, 3.24; 95% CI, 0.66-15.87). The other modalities were assessed as very low certainty (HD-WLE with SR: RR, 1.35; 95% CI, 0.66-2.77; AFI: RR, 1.18; 95% CI, 0.55-2.57; HD-VCE: RR, 0.99; 95% CI, 0.69-1.43). Sensitivity analyses supported these findings. Limited data on serious adverse events precluded meta-analysis; 2 serious events were reported among 2164 patients (very low certainty).
HD-DCE is the only modality for IBD surveillance with evidence (low-certainty) demonstrating potential to detect more dysplastic lesions compared with HD-WLE. There was no evidence to support any of the other modalities as an alternative due to very low-certainty evidence.
长期炎症性肠病（IBD）会增加结肠肿瘤形成的风险，因此需要有效的筛查策略。这项网状荟萃分析比较了高清（HD）时代不同内镜检查方式之间的疗效和安全性。
我们检索了CENTRAL、ClinicalTrials.gov、Embase、MEDLINE和世界卫生组织，以查找截至2024年2月比较IBD患者结肠镜筛查内镜检查方式的随机对照试验（RCT）。主要结局是每位患者检测到任何发育异常病变。证据的确定性采用GRADE评估。
共纳入26项RCT，涉及4159名参与者，比较了6种内镜检查方式：高清白光内镜检查（HD-WLE）、高清虚拟色素内镜检查（HD-VCE）、高清染料色素内镜检查（HD-DCE）、分段复检的HD-WLE（SR）、自体荧光成像（AFI）和全光谱内镜检查（FUSE）。与HD-WLE相比，HD-DCE在检测发育异常方面可能有微小益处（确定性低，程度小；相对风险[RR]，1.42；95%置信区间[CI]，1.02-1.98）。FUSE与HD-WLE可能无差异（确定性低：RR，3.24；95%CI，0.66-15.87）。其他方式的确定性评估为极低（分段复检的HD-WLE：RR，1.35；95%CI，0.66-2.77；AFI：RR，1.18；95%CI，0.55-2.57；HD-VCE：RR，0.99；95%CI，0.69-1.43）。敏感性分析支持这些结果。关于严重不良事件的数据有限，无法进行荟萃分析；2164名患者中报告了2起严重事件（确定性极低）。
HD-DCE是IBD监测的唯一有证据（确定性低）表明与HD-WLE相比有潜力检测到更多发育异常病变的方式。由于证据确定性极低，没有证据支持其他任何方式作为替代方案。
