Systematic Reviews
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Endosc. May 16, 2020; 12(5): 159-171
Published online May 16, 2020. doi: 10.4253/wjge.v12.i5.159
Efficacy of various endoscopic modalities in detecting dysplasia in ulcerative colitis: A systematic review and network meta-analysis
Bilal Gondal, Haider Haider, Yuga Komaki, Fukiko Komaki, Dejan Micic, David T Rubin, Atsushi Sakuraba
Bilal Gondal, Haider Haider, Yuga Komaki, Fukiko Komaki, Dejan Micic, David T Rubin, Atsushi Sakuraba, Section of Gastroenterology, Hepatology and Nutrition, Department of Medicine, The University of Chicago Medicine, Chicago, IL 60637, United States
Bilal Gondal, Section of Gastroenterology, Carle Hospital, University of Illinois, Urbana, IL 61801, United States
Yuga Komaki, Fukiko Komaki, Digestive and Lifestyle Diseases, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima 890-8544, Japan
Author contributions: Gondal B, Komaki Y, Komaki F and Sakuraba A analyzed data; Gondal B drafted manuscript; Komaki Y and Komaki F and drafted figures; Haider H, Micic D and Rubin DT are responsible for critical review and approval of manuscript; Sakuraba A studied concept and design and wrote manuscript.
Conflict-of-interest statement: All authors testify that there are no disclosures or competing interests relevant to this publication.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Atsushi Sakuraba, MD, PhD, Assistant Professor, Department of Medicine, The University of Chicago Medicine, 5841 S, Maryland Ave, MC 4076, Chicago, IL 60637, United States. asakurab@medicine.bsd.uchicago.edu
Received: February 18, 2020
Peer-review started: February 18, 2020
First decision: March 28, 2020
Revised: April 12, 2020
Accepted: May 12, 2020
Article in press: May 12, 2020
Published online: May 16, 2020
Abstract
BACKGROUND

Longstanding ulcerative colitis (UC) is associated with an increased risk of colonic neoplasia. Various endoscopic modalities, such as chromoendoscopy (CE), narrow band imaging (NBI) and random biopsy have been introduced for surveillance, however, there exists a paucity of direct comparisons between them. We aimed to conduct a network meta-analysis of randomized controlled trials (RCTs) performed for surveillance of neoplasia in UC.

AIM

To provide a comparative evaluation of the efficacy of the above-mentioned various modalities.

METHODS

We searched MEDLINE/PubMed, Web of Science, Embase, Google Scholar and Cochrane Central Registry through May 2016 for RCTs evaluating the efficacy of endoscopic modalities for surveillance of neoplasia in UC. The primary outcomes of interest were dysplasia (low- or high-grade) detection rates per biopsy and per patient, and dysplasia numbers per patient. Studies were simultaneously analyzed using a random-effects network meta-analysis under the Bayesian framework to identify the modality with the highest dysplasia detection rate. The best ranking probability for the dysplasia detection rate was analyzed by surface under the cumulative ranking (SUCRA) technique.

RESULTS

Six prospective RCTs of a total 1038 patients were identified. We identified 4 different modalities; white light (WL) high definition (HD) or standard definition (SD), CE HD, and NBI HD. For dysplasia per biopsy, direct meta-analysis showed superiority of NBI HD over WL HD and CE HD over WL SD. Network meta-analysis demonstrated the rank order of best modality as NBI HD, CE HD, WL HD and WL SD with close SUCRA scores of the first two. For dysplasia per patient, direct meta-analyses showed equivocal results between each modality. Network meta-analysis demonstrated the rank order of best modality as WL HD, NBI HD, CE HD and WL SD with small differences of the SUCRA score among the first two. For dysplasia numbers per patient, direct meta-analysis showed superiority of CE HD over WL SD. Network meta-analysis demonstrated the rank order of best modality as WL HD, NBI HD, CE HD, and WL SD with small differences of the SUCRA score among the first three.

CONCLUSION

We demonstrated that there were small differences among WL HD, NBI HD, and CE HD, while WL SD was inferior, in detecting dysplasia in UC.

Keywords: Ulcerative colitis, Surveillance, Dysplasia, Network meta-analysis, Endoscopy

Core tip: Ulcerative colitis (UC) is associated with increased neoplasia risk. Chromoendoscopy (CE), narrow band imaging (NBI) and random biopsy are used for surveillance, but data is limited to conclude best surveillance rank order. We did a network meta-analysis of UC surveillance randomized controlled trials. We identified 4 modalities; white light (WL) high definition (HD) or standard definition (SD), CE HD, and NBI HD. Results showed no differences among WL HD, NBI HD, and CE HD, while WLSD was inferior. The use of HD colonoscopes with or without image enhancement may provide improved detection of dysplasia in UC surveillance.