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P171 Augmented endoscopy for surveillance of colonic inflammatory bowel disease: systematic review with network meta-analysis

F. Castiglione1, N. Imperatore*1, A. Testa1, G. D. De Palma2, L. Pellegrini1, N. Caporaso1, A. Rispo1, IBD Naples1

1Gastroenterology, School of Medicine Federico II of Naples, Naples, Italy, 2Surgical Endoscopy, School of Medicine Federico II of Naples, Naples, Italy

Background

Considering the high risk of dysplasia and cancer in inflammatory bowel disease (IBD), surveillance is advocated. However, international guidelines do not reach a uniform recommendation on the way to perform surveillance. We performed a systematic review with a meta-analysis to assess the best endoscopic surveillance strategy in colonic IBD.

Methods

The systematic review was performed in PubMed/MEDLINE, EMBASE, SCOPUS and Cochrane databases to identify studies comparing white light endoscopy (WLE) and augmented endoscopy (AE) in the detection of dysplasia or neoplasia in colonic IBD. Sub-analyses between dye-spray chromoendoscopy (DCE), narrow-band imaging (NBI), I-SCAN, full-spectrum endoscopy (FUSE) and auto-fluorescence imaging (AFI), and the role of random vs. targeted biopsies were also performed. Furthermore, a meta-regression and a network meta-analysis were also performed.

Results

Twenty-seven studies (6167 IBD patients with 2024 dysplastic lesions) met the inclusion criteria. There was no publication bias. AE showed a higher likelihood of detecting dysplastic lesions than WLE (19.3% vs. 8.5%, OR = 2.036), with an incremental yield (IY) of 10.8%. DCE (OR = 2.605) and AFI (OR = 3.055) had higher likelihood of detecting adenomas than WLE; otherwise, I-SCAN (OR = 1.096), NBI (OR = 0.650) and FUSE (OR = 1.118) were not superior to WLE. Dysplasia was found in 1256/7267 targeted biopsies (17.3%) and in 363/110040 random biopsies (0.33%) (OR = 66.559, IY = 16.9%). Meta-regression found no variable impacting the efficacy of AE techniques. Network meta-analysis identified a significant superiority of DCE on WLE in detecting dysplasia (OR = 2.12), while no other single technique was found to be superior to all others in adenoma detection.

Conclusion

AE, especially DCE, was associated with higher likelihood of discovering dysplastic lesions than WLE. Chromoendoscopy with targeted biopsies is the best endoscopic technique for IBD surveillance.