Detecting dysplasia in IBD: chromoendoscopy is better than white light endoscopy

  • Wan J & al.
  • J Dig Dis
  • 12 Feb 2019

  • curated by Emily Willingham, PhD
  • Clinical Essentials
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Takeaway

  • For detecting dysplasia in IBD, chromoendoscopy (CE) bests white light endoscopy (WLE) for detecting nonpolypoid lesions.
  • This meta-analysis also shows CE superiority over high-definition (HD) WLE.

Why this matters

  • Recent findings have been mixed, some leaning toward CE as a replacement for WLE but others pointing to no increased detection with CE.

Key results

  • CE bested WLE for (risk ratios, 95% CIs):
    • Dysplasia detection: 2.05 (1.62-2.61; P<.00001 limited heterogeneity>).
    • Dysplastic lesion detection: 2.04 (1.40-2.98; P=.0002; significant heterogeneity).
    • Nonpolypoid dysplastic lesion detection: 1.38 (1.02-1.88; P=.04; limited heterogeneity).
  • CE also bested HD-WLE in dysplasia detection, but did not beat WLE for polypoid lesion identification (0.74; 0.53-1.05; P=.09).

Study design

  • Meta-analysis, 6 randomized controlled trials (n=911), 5 prospective studies (n=1327).
  • Funding: Natural Science Foundation of China. 

Limitations

  • Not all studies compared CE and WLE on the same lesions.
  • Multiple endoscopists with variable experience involved in some studies.

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