Image-enhanced, chromo, and cap-assisted colonoscopy for improving adenoma/neoplasia detection rate: a systematic review and meta-analysis. (February 2014)

• Record Type: Journal Article
• Authors: Omata, Fumio; Ohde, Sachiko; Deshpande, Gautam A.; Kobayashi, Daiki; Masuda, Katsunori; Fukui, Tsuguya
• Is Part Of: Scandinavian journal of gastroenterology. Volume 49:Number 2(2014)
• Page Start: 222
• Page End: 237
• Publication Date: 2014-02
• Subjects: Gastroenterology -- Periodicals; Digestive organs -- Diseases -- Periodicals; 616.33
• DOI: 10.3109/00365521.2013.863964
• Languages: English
• ISSNs: 0036-5521

Abstract

<abstract> <title>Abstract</title> <p> <bold> <italic>Objective.</italic> </bold> The effectiveness of narrow band imaging (NBI), chromoendoscopy (CE), and cap-assisted colonoscopy (CAC) on adenoma detection rate (ADR) has been investigated in previous meta-analyses; however, there have been no meta-analyses of autofluorescence imaging (AFI) or flexible spectral imaging color enhancement (FICE) or i-scan. The aim of this study was to determine whether AFI and FICE/i-scan was more effective than standard/high-definition white light endoscopy to improve ADR and to update previous meta-analyses of NBI, CE, and CAC. <bold><italic>Design.</italic></bold> A systematic review and meta-analysis was conducted. Four investigators selected appropriate randomized controlled trials (RCT) using the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guideline. All RCTs in which colonoscopy were performed with AFI, FICE, i-scan, NBI, CE, and CAC were included. The risk ratios (RRs) calculated from adenoma/neoplasia detection rate were used as the main outcome measurement. <bold><italic>Results.</italic></bold> A total of 42 studies were included in the analysis. Pooled estimates of RR (95%confidence interval [CI]) using AFI, FICE/i-scan, NBI, CE, and CAC were 1.04 (95% CI: 0.87–1.24) (<italic>I</italic><sup>2</sup> = 0%) (fixed effects model [FEM]); 1.09 (95% CI: 0.97–1.23) (<italic>I</italic><sup>2</sup> = 5%) (FEM); 1.03 (95% CI: 0.96–1.11) (<italic>I</italic><sup>2</sup> = 0%) (FEM); 1.36 (95% CI: 1.23–1.51) (<italic>I</italic><sup>2</sup> = 16%) (FEM); and 1.03 (95% CI: 0.93–1.14) (<italic>I</italic><sup>2</sup> = 48%) (random effects model [REM]), respectively. The pooled estimate of RR (95%CI) using indigo carmine in non-ulcerative colitis (UC) patients and methylene blue in UC patients was 1.33 (95% CI: 1.20–1.48) (<italic>I</italic><sup>2</sup> = 14%) (FEM) and 2.39 (95% CI: 1.18–4.84) (<italic>I</italic><sup>2</sup> = 0%) (FEM), respectively. <bold><italic>Conclusion.</italic></bold> In contrast to AFI, FICE/i-scan, NBI, and CAC, only CE improves ADR. CE with methylene blue, though not NBI, is effective for surveillance of neoplasia in chronic UC patients.</p> </abstract>