Published online Mar 14, 2018. doi: 10.3748/wjg.v24.i10.1167
Peer-review started: January 9, 2018
First decision: February 5, 2018
Revised: February 18, 2018
Accepted: February 15, 2018
Article in press: February 15, 2018
Published online: March 14, 2018
To perform a systematic review and meta-analysis for the diagnostic accuracy of in vivo lesion characterization in colonic inflammatory bowel disease (IBD), using optical imaging techniques, including virtual chromoendoscopy (VCE), dye-based chromoendoscopy (DBC), magnification endoscopy and confocal laser endomicroscopy (CLE).
We searched Medline, Embase and the Cochrane library. We performed a bivariate meta-analysis to calculate the pooled estimate sensitivities, specificities, positive and negative likelihood ratios (+LHR, -LHR), diagnostic odds ratios (DOR), and area under the SROC curve (AUSROC) for each technology group. A subgroup analysis was performed to investigate differences in real-time non-magnified Kudo pit patterns (with VCE and DBC) and real-time CLE.
We included 22 studies [1491 patients; 4674 polyps, of which 539 (11.5%) were neoplastic]. Real-time CLE had a pooled sensitivity of 91% (95%CI: 66%-98%), specificity of 97% (95%CI: 94%-98%), and an AUSROC of 0.98 (95%CI: 0.97-0.99). Magnification endoscopy had a pooled sensitivity of 90% (95%CI: 77%-96%) and specificity of 87% (95%CI: 81%-91%). VCE had a pooled sensitivity of 86% (95%CI: 62%-95%) and specificity of 87% (95%CI: 72%-95%). DBC had a pooled sensitivity of 67% (95%CI: 44%-84%) and specificity of 86% (95%CI: 72%-94%).
Real-time CLE is a highly accurate technology for differentiating neoplastic from non-neoplastic lesions in patients with colonic IBD. However, most CLE studies were performed by single expert users within tertiary centres, potentially confounding these results.
Core tip:In vivo lesion characterization in colonic inflammatory bowel disease presents many challenges. Lesions tend to be morphologically different and potentially associated with surrounding/overlying inflammation, obscuring the pit pattern. The ability to accurately characterize lesions in vivo could reduce costs and complications by decreasing the need for polypectomies. Virtual chromoendoscopy (VCE) and dye-based chromoendoscopy currently cannot be recommended for lesion characterization. Confocal laser endomicroscopy is an accurate technology at differentiating neoplastic from non-neoplastic lesions but studies within this meta-analysis involved single expert center with single advanced endoscopic operators, reducing its generalizability. Larger studies are required specifically looking at lesion characterization, especially with rapid technological advancements in VCE (Narrow band imaging, i-scan, Fujinon intelligence chromoendoscopy).