Comparative Efficacy and Safety of Endoscopic Modalities for Colorectal Cancer Screening in Inflammatory Bowel Disease: A Systematic Review and Network Meta-Analysis

Vasiliki Sinopoulou; Gaurav B Nigam; Morris Gordon; Meghana Ganeshan; Mitchell Rudo Tokonyai; Sunil Dolwani; Marietta Iacucci; Matt Rutter; Venkat Subramanian; Ana Wilson; British Society of Gastroenterology Colorectal IBD Surveillance Guideline Development Group; James E East

doi:10.1016/j.cgh.2024.11.008

Comparative Efficacy and Safety of Endoscopic Modalities for Colorectal Cancer Screening in Inflammatory Bowel Disease: A Systematic Review and Network Meta-Analysis

Clin Gastroenterol Hepatol. 2024 Dec 13:S1542-3565(24)01073-5. doi: 10.1016/j.cgh.2024.11.008. Online ahead of print.

Collaborators

British Society of Gastroenterology Colorectal IBD Surveillance Guideline Development Group:
Ibrahim Al Bakir, Adrian Bateman, Shahida Din, Anjan Dhar, Omar Faiz, Bu Hayee, Chris Healey, Chris A Lamb, Simon Leedham, Misha Kabir, Ailsa Hart, John Morris, Marco Novelli, Tim Raine, Neil Shepherd, Nigel Trudgill, Maggie Vance, Lydia White, Ruth Wakeman

Affiliations

¹ University of Central Lancashire, School of Medicine, Preston, Lancashire, UK.
² Translational Gastroenterology Unit, Nuffield Department of Medicine, John Radcliffe Hospital, University of Oxford, Oxford, UK.
³ School of Medicine, University of Central Lancashire, Preston, Lancashire, UK. Electronic address: mgordon@uclan.ac.uk.
⁴ School of Medicine, University of Central Lancashire, Preston, Lancashire, UK.
⁵ School of Medicine and Cardiff and Vale University Health Board, Cardiff University, Cardiff, UK.
⁶ College of Medicine and Health, University College of Cork and APC Microbiome, Cork, Ireland; Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK.
⁷ Gastroenterology, University Hospital of North Tees, Stockton-on-Tees, United Kingdom of Great Britain and Northern Ireland.
⁸ Leeds Gastroenterology Institute, Leeds Teaching Hospitals NHS trust, Leeds, UK.
⁹ St Mark's Hospital and Academic Institute, Harrow, UK; Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK.
¹⁰ Translational Gastroenterology Unit, Nuffield Department of Medicine, John Radcliffe Hospital, University of Oxford, Oxford, UK. Electronic address: James.east@ndm.ox.ac.uk.

PMID: 39675405
DOI: 10.1016/j.cgh.2024.11.008

Abstract

Background: Long-standing Inflammatory bowel disease (IBD) increases the risk of colonic neoplasia, necessitating effective screening strategies. This network meta-analysis (NMA) compared the efficacy and safety between different endoscopic modalities in the high-definition (HD) era.

Methods: We searched CENTRAL, ClinicalTrials.gov, Embase, MEDLINE, and WHO for randomised controlled trials (RCTs) comparing endoscopic modalities for screening colonoscopy in IBD patients up to February 2024. The primary outcome was detection of any dysplastic lesion per patient. The certainty of the evidence was GRADE assessed.

Results: A total of 26 RCTs involving 4,159 participants were included, comparing 6 endoscopic modalities: HD white light endoscopy (HD-WLE), HD virtual chromoendoscopy (HD-VCE), HD dye-based chromoendoscopy (HD-DCE), HD-WLE with segmental re-inspection (SR), auto-fluorescence imaging (AFI), and full-spectrum endoscopy (FUSE). HD-DCE may have a small benefit in detecting dysplasia over HD-WLE (low certainty, small magnitude, RR 1.42, 95% CI: 1.02-1.98). FUSE may be no different to HD-WLE (low certainty, RR 3.24, 95% CI: 0.66-15.87). The other modalities were assessed as very low certainty (HD-WLE with SR: RR 1.35, 95% CI: 0.66-2.77; AFI: RR 1.18, 95% CI: 0.55-2.57; HD-VCE: RR 0.99, 95% CI: 0.69-1.43). Sensitivity analyses supported these findings. Limited data on serious adverse events precluded meta-analysis; 2 serious events were reported among 2164 patients (very low certainty).

Conclusions: HD-DCE is the only modality for IBD surveillance with evidence (low-certainty) demonstrating potential to detect more dysplastic lesions compared to HD-WLE. There was no evidence to support any of the other modalities as an alternative due to very low-certainty evidence.

Keywords: Chromoendoscopy; Colorectal cancer screening; Dye-based chromoendoscopy (DCE); Dysplasia; Endoscopic surveillance; High-definition endoscopy; Inflammatory bowel disease (IBD); Network meta-analysis; Virtual chromoendoscopy (VCE); White light endoscopy (WLE).