Shehab Mohammad, Al-Hindawi Ahmed, Alrashed Fatema, Murthy Sanjay, Bisschops Raf, Hoentjen Frank, Barkun Alan, Singh Siddharth, Bessissow Talat
Division of Gastroenterology, Department of Internal Medicine, Mubarak Alkabeer University Hospital, Kuwait University, Kuwait City, Kuwait.
School of Medicine, Royal College of Surgeons in Ireland - Medical University of Bahrain, Busaiteen, Bahrain.
Aliment Pharmacol Ther. 2025 Mar;61(6):938-949. doi: 10.1111/apt.18500. Epub 2025 Jan 18.
Novel colorectal cancer endoscopic surveillance techniques for inflammatory bowel disease (IBD) have recently been developed.
Compare the efficacy of currently available techniques for dysplasia detection in colonic IBD.
We conducted a systematic literature search from inception to March 2024 for randomized controlled trials (RCTs) or prospective cohort studies enrolling adults with IBD and having surveillance colonoscopy for dysplasia screening. Primary outcome was the number of dysplastic lesions (per-lesion analysis). Secondary outcome was the number of patients with dysplasia (per-patient analysis). We assessed endpoints using the frequentist NMA random effect model.
We included 25 studies (22 RCTs). 4837 patients met eligibility criteria (850 total dysplastic lesions; 105 with advanced dysplasia). Nine different screening techniques were studied. In per-lesion analysis, dye-based chromoendoscopy (DCE) ranked the highest (83%) per SUCRA ranking. DCE was superior to HD-WLE (OR, 1.78; 95% CI, 1.06-3.00). There were no significant differences between NBI and DCE, HD-WLE with SR or CEM in head-to-head comparisons. In a sub-analysis confined to ulcerative colitis (UC), DCE ranked highest (98%) with per-lesion analysis, and was superior to NBI (OR, 1.69; 95% CI, 1.03-2.77).
HD-WLE-SR, DCE and CEM demonstrated superiority over other techniques for detection of dysplasia in colonic IBD. DCE was superior for dysplasia detection in colonic IBD. DCE was superior to HD-WLE in colonic IBD. DCE was the best technique in UC. Further studies to compare HD-WLE-SR and NBI with DCE are warranted to ascertain performance equivalency and define the optimal surveillance technique.
近年来已开发出用于炎症性肠病（IBD）的新型结直肠癌内镜监测技术。
比较目前可用技术在结肠IBD中检测发育异常的疗效。
我们进行了一项系统的文献检索，从起始到2024年3月，检索纳入患有IBD的成年人并进行监测结肠镜检查以筛查发育异常的随机对照试验（RCT）或前瞻性队列研究。主要结局是发育异常病变的数量（每病变分析）。次要结局是患有发育异常的患者数量（每患者分析）。我们使用频率学派网络Meta分析随机效应模型评估终点。
我们纳入了25项研究（22项RCT）。4837名患者符合纳入标准（共850个发育异常病变；105个高级别发育异常）。研究了九种不同的筛查技术。在每病变分析中，基于染料的色素内镜检查（DCE）根据SUCRA排名最高（83%）。DCE优于高清白光内镜检查（HD-WLE）（OR，1.78；95%CI，1.06 - 3.00）。在直接比较中，窄带成像（NBI）与DCE、带智能分光比色法（SR）的HD-WLE或共聚焦激光显微内镜检查（CEM）之间无显著差异。在仅限于溃疡性结肠炎（UC）的亚组分析中，每病变分析时DCE排名最高（98%），且优于NBI（OR，1.69；95%CI，1.03 - 2.77）。
HD-WLE-SR、DCE和CEM在检测结肠IBD发育异常方面优于其他技术。DCE在检测结肠IBD发育异常方面更具优势。在结肠IBD中DCE优于HD-WLE。在UC中DCE是最佳技术。有必要进一步开展研究比较HD-WLE-SR和NBI与DCE，以确定性能等效性并确定最佳监测技术。
