Enhanced dysplasia detection in inflammatory bowel disease: A comprehensive meta-analysis of dye-based chromoendoscopy versus high-definition white light endoscopy.

Abstract

e15135 Background: Patients with inflammatory bowel disease (IBD), particularly those with long-standing ulcerative colitis, are at a higher risk of developing colorectal cancer. Surveillance colonoscopy is critical for detecting dysplasia early. This meta-analysis investigates the efficacy of dye-based chromoendoscopy (DCE) compared to high-definition white-light endoscopy (HD-WLE) for identifying dysplasia in IBD patients. Methods: A thorough search of PubMed, EMBASE, and Web of Science databases was conducted to identify randomized controlled trials (RCTs) comparing DCE and HD-WLE in IBD patients undergoing colonoscopic surveillance. The primary endpoint was the proportion of patients with at least one dysplastic lesion identified. Odds ratios (OR) with 95% confidence intervals (CI) were calculated using a random-effects model, and heterogeneity was assessed using the I² statistic. Analysis was performed using RevMan 5.3 reporting odds of detecting dysplasia. Results: This meta-analysis included seven RCTs comprising 1,050 patients (DCE = 510; HD-WLE = 540). Dye-based chromoendoscopy identified dysplasia in a significantly higher percentage of patients compared to high-definition white-light endoscopy (19.7% vs. 11.2%), with an odds ratio (OR) of 2.14 (95% CI 1.35–3.42, I² = 23%, P = 0.004). Subgroup analysis excluding two studies available only as abstracts confirmed the robustness of these findings. High-grade dysplasia detection was higher in the DCE group (3.3%) compared to the HD-WLE group (1.5%); however, this difference did not reach statistical significance (OR 2.48, 95% CI 0.75–8.12, I² = 0%). Despite the lack of statistical significance for high-grade dysplasia, the overall results demonstrated the superiority of DCE for dysplasia detection. The heterogeneity for overall dysplasia detection was low (I² = 23%), and the quality of evidence assessed through GRADE was high for detecting any dysplasia. These findings suggest that DCE provides significant advantages in identifying dysplasia during surveillance colonoscopy in patients with inflammatory bowel disease. Conclusions: This analysis indicates that DCE is more effective than HD-WLE in detecting dysplasia in IBD patients, even when high-definition imaging technology is used. DCE should be prioritized for surveillance in high-risk IBD patients when expertise is available. Future multicenter studies with diverse operators and extended follow-up are necessary to evaluate its impact on cancer prevention and overall survival.