P252 Is the time for chromoendoscopy spreading in dysplasia surveillance of inflammatory bowel diseases? A systematic review with meta-analysis
A. Iannone*, G. Losurdo, M. Barone, E. Ierardi, A. Di Leo, M. PRINCIPI
University of Bari, DETO, Bari, Italy
A previous meta-analysis identified chromoendoscopy (CE) as technique of choice for dysplasia surveillance in inflammatory bowel diseases (IBD). Nevertheless, successive studies reported a similar performance of CE and conventional white light endoscopy (WLE) in this setting. Our aim was to perform an updated meta-analysis comparing CE and WLE efficacy in the detection of dysplastic lesions amongst IBD patients undergoing surveillance colonoscopy.
We searched in MEDLINE, EMBASE, PubMed, Scopus, and Web-of-Science electronic databases for all references including the terms inflammatory bowel disease, Crohn’s, or ulcerative colitis, and chromoendoscopy. We evaluated the following outcomes: number of patients diagnosed with dysplasia, detection of any dysplastic lesion, detection of flat dysplastic lesions, and duration of the procedure. The random-effects model was used because it represents a conservative method that considers different sources of variation amongst studies. The heterogeneity was tested with Q and I2 statistics. Sensitivity analysis was performed by excluding 1 study at a time. Publication bias was assessed using Egger’s and trim and fill tests.
Twelve studies involving 3 954 patients were included in the meta-analysis. CE showed higher efficacy in identifying patients with dysplasia (OR = 2.41; 95% CI 1.77–3.28; p < 0.001). Additionally, CE demonstrated higher performance in detecting both any type of dysplasia (RR = 2; 95% CI 1.48–2.71; p < 0.001) and flat dysplastic lesions (RR = 4.01; 95% CI 2.24–7.18; p < 0.001). Conversely, WLE showed a shorter time of procedure (Cohen’s d = -0.98; 95% CI -1.56, -0.41; p = 0.001). This effect was negatively affected by pancolitis percentages in examined samples. Sensitivity analyses did not show any significant change in overall effect sizes. No publication bias was observed.
Our meta-analysis, performed in a greater sample of IBD patients, supports the matter of higher efficacy of CE over WLE for dysplasia detection. Moreover, the time gap between procedures may be affected by pancolitis.