Copyright ©The Author(s) 2018. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Mar 14, 2018; 24(10): 1167-1180
Published online Mar 14, 2018. doi: 10.3748/wjg.v24.i10.1167
Colonic lesion characterization in inflammatory bowel disease: A systematic review and meta-analysis
Richard Lord, Nicholas E Burr, Noor Mohammed, Venkataraman Subramanian
Richard Lord, Nicholas E Burr, Noor Mohammed, Venkataraman Subramanian, Department of Gastroenterology, Leeds Teaching Hospitals NHS Trust, Leeds LS97TF, United Kingdom
Richard Lord, Nicholas E Burr, Venkataraman Subramanian, University of Leeds, Leeds Institute of Biomedical and Clinical Sciences, Leeds LS97TF, United Kingdom
Author contributions: Subramanian V envisaged and designed the research; Subramanian V performed the statistical analysis; Lord R wrote the paper and did the information searching; Lord R and Burr NE performed the Selection of papers and data abstraction; Lord R and Mohammed N performed the study quality analysis; all authors have reviewed the manuscript.
Conflict-of-interest statement: The authors deny any conflict of interest.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (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:
Correspondence to: Venkataraman Subramanian, CCST, MBBS, MD, MRCP, Assistant Professor, Department of gastroenterology, Leeds Teaching Hospitals NHS Trust, Beckett St, Leeds LS97TF, United Kingdom.
Telephone: +44-113-2068691 Fax: +44-113-2068688
Received: January 8, 2018
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
Research background

Patients with inflammatory bowel disease (IBD) colitis are known to have an increased risk of colorectal cancer compared to that of non-colitic patients. This is thought to progress along the inflammation-dysplasia-carcinoma pathway. Many studies and meta-analyses have been performed for lesion detection in IBD but few studies have looked into in-vivo lesion characterization. This is the first meta-analysis on lesion characterization in colonic IBD.

Research motivation

Characterization of colonic lesions in IBD maybe more challenging because they tend to be flatter and their pit-pattern maybe obscured by inflammation. Some patients also have numerous pseudopolyps throughout the colon, making polypectomy impractical, time-consuming, costly and potentially associated with increased risk. If we are able to characterize these lesions with a high accuracy without needing to perform polypectomy, we could potentially circumvent these problems.

Research objectives

Our objective was to perform the first systematic review and meta-analysis for the diagnostic accuracy of optical imaging techniques for in-vivo lesion characterization in colonic IBD.

Research methods

We conducted a review of the current literature and included studies which characterized lesions in-vivo into neoplastic and non-neoplastic, using histology as the gold standard. Data was pooled for each technology using a bivariate meta-analysis with a random effects model to account for study differences. Sensitivities, specificities, positive and negative likelihood ratios, diagnostic odds ratio, and area under summary receiver-operator characteristic curve, were calculated for each technology type.

Research results

Confocal laser endomicroscopy (CLE) had the greatest accuracy for differentiating neoplastic from non-neoplastic lesions in-vivo. Magnification and virtual chromoendoscopy (VCE) performed well, whilst dye-based chromoendoscopy (DBC) had suboptimal accuracy.

Research conclusions

CLE is highly accurate at in-vivo lesion characterization but studies are within experienced centres with mainly single expert users limiting its generalizability.

Research perspectives

Future studies should look at newer generation virtual chromoendoscopic technology [narrow band imaging (NBI), i-scan, fujinon intelligence chromoendoscopy (FICE)] for lesion characterization. A standardised mucosal lesion classification system specific for lesions in IBD colitis accounting for the technology being used should be explored.