Huang Chih-Wen, Yen Hsu-Heng, Chen Yang-Yuan
Division of Gastroenterology, Changhua Christian Hospital, Changhua, Taiwan.
College of Medicine, Graduate Institute of Clinical Medicine, National Taiwan University, Taipei, Taiwan.
United European Gastroenterol J. 2025 Mar 27. doi: 10.1002/ueg2.70017.
Dye-based chromoendoscopy (DCE) has been the preferred method for colonoscopy surveillance in patients with inflammatory bowel disease (IBD). However, with advances in endoscopy, virtual chromoendoscopy (VCE) techniques have emerged. This network meta-analysis evaluates the effectiveness of different endoscopy techniques for IBD patient surveillance.
Sixteen randomized controlled trials involving 2514 patients were included in the analysis, comparing endoscopy techniques in IBD patient surveillance: DCE, high-definition white light endoscopy (WLE), standard-definition WLE, i-scan, narrow band imaging (NBI), flexible spectral imaging color enhancement (FICE), and autofluorescence imaging (AFI). We assessed the per patient neoplasia detection rate, positive predictive value (PPV), and withdrawal time between different endoscopy techniques. Moreover, subgroup analysis was conducted to investigate the neoplasia detection rate according to endoscopy techniques using various biopsy protocols.
Comparing neoplasia detection rates revealed that only DCE (OR: 2.56 [1.17-5.59]) significantly increased the neoplasia detection rate compared with standard-definition WLE. The subsequent rankings were high-definition WLE, NBI, FICE, i-scan, and AFI. Moreover, the PPVs of DCE, VCE, and high-definition WLE showed no significant difference compared with that of standard-definition WLE. However, DCE required a significantly longer withdrawal time. Subgroup analysis showed that DCE with random biopsy or target biopsy and high-definition WLE with target biopsy had superior neoplasia detection rates than standard-definition WLE with random biopsy.
DCE significantly outperforms standard-definition WLE in neoplasia detection rates, with random biopsy providing additional benefits. Although DCE does not lower PPV, it requires more withdrawal time. If DCE-based surveillance is not feasible, high-definition WLE with targeted biopsy should be considered as other VCE techniques offer no significant advantages.
基于染料的色素内镜检查（DCE）一直是炎症性肠病（IBD）患者结肠镜监测的首选方法。然而，随着内镜技术的进步，虚拟色素内镜检查（VCE）技术应运而生。这项网状荟萃分析评估了不同内镜技术用于IBD患者监测的有效性。
分析纳入了16项涉及2514例患者的随机对照试验，比较了IBD患者监测中的内镜技术：DCE、高清白光内镜检查（WLE）、标准清晰度WLE、i-scan、窄带成像（NBI）、灵活光谱成像颜色增强（FICE）和自体荧光成像（AFI）。我们评估了不同内镜技术的每例患者肿瘤检测率、阳性预测值（PPV）和退镜时间。此外，进行亚组分析以根据使用各种活检方案的内镜技术研究肿瘤检测率。
比较肿瘤检测率发现，与标准清晰度WLE相比，只有DCE（比值比：2.56 [1.17 - 5.59]）显著提高了肿瘤检测率。随后的排名依次为高清WLE、NBI、FICE、i-scan和AFI。此外，与标准清晰度WLE相比，DCE、VCE和高清WLE的PPV无显著差异。然而，DCE需要显著更长的退镜时间。亚组分析表明，随机活检或靶向活检的DCE以及靶向活检的高清WLE的肿瘤检测率优于随机活检的标准清晰度WLE。
在肿瘤检测率方面，DCE明显优于标准清晰度WLE，随机活检可带来额外益处。虽然DCE不会降低PPV，但需要更多的退镜时间。如果基于DCE的监测不可行，鉴于其他VCE技术没有显著优势，应考虑采用靶向活检的高清WLE。
