P172 - CHROMOENDOSCOPY VERSUS HIGH DEFINITION WHITE LIGHT ENDOSCOPY FOR DYSPLASIA DETECTION IN PATIENTS WITH INFLAMMATORY BOWEL DISEASE: A SYSTEMATIC REVIEW AND META-ANALYSIS
(Room Poster Hall)
19 Jan 18
5:30 PM
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7:00 PM
Tracks:
Management of Complicated IBD
Introduction: Current guidelines endorsed by several societies suggest the use of spray chromoendoscopy (CE) to improve dysplasia detection during surveillance colonoscopy in patients with long standing IBD. Our goal was to compare dysplasia detection rates between CE and HD-WLE in randomized controlled trials (RCTs) and observational studies conducted in IBD patients undergoing surveillance colonoscopy. Methods: Electronic database search was conducted in Pubmed, Embase, Google Scholar and Cochrane for eligible studies. Studies comparing HD-WLE to CE for dysplasia detection rate (per-patient) in patients with IBD undergoing surveillance colonoscopy were considered. Dysplastic lesion was defined as low grade dysplasia, high grade dysplasia and adenocarcinoma. Results: A total of 6 studies (3 RCTs and 3 observational studies) that directly compared HD-WLE vs CE were found eligible for analysis of dysplasia detection rate. On analyzing all 6 studies, including observational studies, a total of 670 patients with IBD underwent CE for surveillance while 688 patients underwent HD-WLE for surveillance of dysplasia. CE was noted to detect more dysplasia compared to HD-WLE (18.8% vs 9%), however this was not statistically significant (p=0.08). Pooled OR was 0.65 (95% CI 0.40-1.05; figure 1). There was moderate heterogeneity in results with I2=23%. If the analysis was restricted to 3 RCTs, a total of 242 IBD patients underwent CE for dysplasia surveillance while 251 IBD patients underwent HD-WLE for surveillance of dysplasia. Again, numerically, CE detected more dysplasia compared to HD-WLE (12.4% vs 10.7%), however this was not statistically significant (p=0.67). Pooled OR was 0.85 (95% CI 0.39-1.84; figure 2). There was moderate heterogeneity in results with I2=37%. Conclusion: In both RCTs and observational studies, HD-WLE was comparable to CE in dysplasia detection rate. Therefore, the current guidelines should be updated to accommodate current evidence.