López-Serrano Antonio, Pretel Luis
Medicina Digestiva, Hospital Universitari Dr. Peset, España.
Facultat de Medicina, Universitat de Valencia.
Rev Esp Enferm Dig. 2025 Mar;117(3):136-147. doi: 10.17235/reed.2025.9878/2023.
Patients with inflammatory bowel disease (IBD) in the colon have a higher risk for colorectal cancer (CRC). Virtual chromoendoscopy (VCE) allows identification and assessment of colonic dysplasia, which might displace dye-based chromoendoscopy (DCE) as the endoscopist's technique of choice for these patients within endoscopic surveillance programs.
to analyze the best evidence available on the usefulness of VCE versus DCE for dysplasia identification in patients with long-standing colonic IBD.
a qualitative, PRISMA 2020-based systematic review of the literature was carried out in the PubMed, Science Direct, and Scielo databases until June 2023. Clinical trials, case-control studies, comparative studies, and crossover studies in English or Spanish were included that directly compared DCE versus VCE for the screening of colonic dysplasia in patients with IBD. The Quality Assessment of Diagnostic Accuracy studies (QUADAS) 2 was used for assessing study quality. The selected studies were evaluated by 2 independent researchers, who entered their abstracted results into a database.
out of 141 identified studies 9 were selected that compared DCE with VCE (1131 patients included). Six studies are prospective, randomized, controlled trials; 2 are retrospective case-control studies; and 1 is a prospective comparative study. VCE showed a dysplasia detection ability similar to that of DCE, albeit with shorter examination times (8 studies; 985 patients). Factors associated with dysplasia identification included lesions in the right colon (3 studies; 581 patients); non-polypoid lesions (1 study; 210 patients) and/or lesions with Kudo's type III-V pit patterns (2 studies; 254 patients); and patient age (1 study; 129 patients).
VCE may be an alternative to DCE for CRC screening in patients with long-standing IBD, with similar detection ability for colonic dysplasia and the benefit of shorter procedure times. Currently available evidence is limited in this regard given the small numbers of patients in the relevant studies, hence further research is necessary with greater numbers of included subjects.
结肠炎症性肠病（IBD）患者患结直肠癌（CRC）的风险更高。虚拟染色内镜检查（VCE）可用于识别和评估结肠发育异常，在内镜监测项目中，它可能会取代基于染料的染色内镜检查（DCE），成为内镜医师对这些患者的首选技术。
分析关于VCE与DCE在长期结肠IBD患者发育异常识别方面有效性的最佳现有证据。
在PubMed、Science Direct和Scielo数据库中进行了基于PRISMA 2020的定性系统文献综述，直至2023年6月。纳入了直接比较DCE与VCE用于IBD患者结肠发育异常筛查的英文或西班牙文的临床试验、病例对照研究、比较研究和交叉研究。使用诊断准确性研究质量评估（QUADAS）2来评估研究质量。选定的研究由2名独立研究人员进行评估，他们将提取的结果输入数据库。
在141项已识别的研究中，选择了9项比较DCE与VCE的研究（纳入1131例患者）。6项研究是前瞻性、随机、对照试验；2项是回顾性病例对照研究；1项是前瞻性比较研究。VCE显示出与DCE相似的发育异常检测能力，尽管检查时间更短（8项研究；985例患者）。与发育异常识别相关的因素包括右半结肠病变（3项研究；581例患者）；非息肉样病变（1项研究；210例患者）和/或具有工藤III - V型凹陷模式的病变（2项研究；254例患者）；以及患者年龄（1项研究；129例患者）。
对于长期IBD患者的CRC筛查，VCE可能是DCE的替代方法，对结肠发育异常具有相似的检测能力，且具有检查时间更短的优势。鉴于相关研究中的患者数量较少，目前这方面的现有证据有限，因此需要纳入更多受试者进行进一步研究。
