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Meta-analysis: the diagnostic yield of chromoendoscopy for detecting dysplasia in patients with colonic inflammatory
V Subramanian1, J Mannath, K Ragunath
1Nottingham Digestive Diseases Centre, Nottingham University Hospital, UK. V.Subramanian@nottingham.ac.uk
Background:
Dysplasia in inflammatory bowel disease (IBD) is often multifocal and flat. Dye spraying is believed to enhance visualisation of subtle mucosal abnormalities.
Aim:
To perform a meta-analysis of the published studies to compare the diagnostic yield of dysplastic lesions in patients with IBD undergoing surveillance colonoscopy between chromoendoscopy and standard white light endoscopy.
Methods:
We searched electronic databases for full journal articles reporting on chromoendoscopy in patients with IBD. Pooled incremental yield of chromoendoscopy over white light endoscopy for dysplasia detection was determined. A fixed effects model was used unless there was significant heterogeneity. Publication bias was assessed using Funnel plots or Egger's test.
Results:
Six studies involving 1277 patients provided data on a number of dysplastic lesions detected. The difference in yield of dysplasia between chromoendoscopy and white light endoscopy was 7% (95% CI 3.2-11.3) on a per patient analysis with an NNT of 14.3. The difference in proportion of lesions detected by targeted biopsies was 44% (95% CI 28.6-59.1) and flat lesions was 27% (95% CI 11.2-41.9) in favour of chromoendoscopy.
Conclusions:
Chromoendoscopy is significantly better than white light endoscopy in detecting dysplasia in patients with colonic IBD. This holds true for all dysplastic lesions, proportion of targeted lesions and proportion of flat lesions detected.
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