Impact of Electronic Chromoendoscopy on Adenoma Miss Rates During Colonoscopy: A Systematic Review and Meta-analysis. Issue 9 (September 2019)

• Record Type: Journal Article
• Authors: Desai, Madhav; Viswanathan, Lavanya; Gupta, Neil; Kennedy, Kevin F.; Repici, Alessandro; Hassan, Cesare; Sharma, Prateek
• Is Part Of: Diseases of the colon & rectum. Volume 62:Issue 9(2019)
• Publication Date: 2019-09
• Subjects: Adenoma miss rate -- Electronic chromoendoscopy -- Image-enhanced endoscopy; Colon (Anatomy) -- Diseases -- Periodicals; Rectum -- Diseases -- Periodicals; Colonic Diseases -- Periodicals; Colorectal Surgery -- Periodicals; 616.34
• DOI: 10.1097/DCR.0000000000001419
• Languages: English
• ISSNs: 0012-3706

Abstract

Abstract : BACKGROUND: The impact of virtual chromoendoscopy such as narrow-band imaging, Fujinon intelligent chromoendoscopy, blue-light imaging, linked-color imaging, and i-SCAN on adenoma detection rate has been variable. However, adenoma miss rate (another measure suggested as a quality indicator) of electronic chromoendoscopy modalities has not been systematically evaluated. OBJECTIVES: This study aimed to perform a systematic review and meta-analysis to examine the adenoma miss rate of white-light endoscopy compared with electronic chromoendoscopy. DATA SOURCES: Medline, Embase, Scopus, Web of Knowledge, and Cochrane were the data sources for this study. STUDY SELECTION: The studies selected were tandem randomized controlled trials of electronic chromoendoscopy modalities compared with white-light endoscopy. INTERVENTIONS: Electronic chromoendoscopy compared with white light endoscopy was used to measure the adenoma miss rate. MAIN OUTCOME MEASURES: Primary outcome was the pooled adenoma miss rate of electronic chromoendoscopy techniques compared with white-light endoscopy. Secondary outcomes were subgroup analysis, adenoma size analysis, and adenoma detection rate. RESULTS: A total of 3507 patients were evaluated from 7 eligible tandem randomized control trials. A total of 1423 patients had white-light endoscopy as the first of the tandem examinations. The rest of the patients had electronic chromoendoscopy as the first of the tandem examination (narrow-band imaging, 988 patients; Fujinon intelligent chromoendoscopy, 728 patients; i-SCAN, 233 patients; blue-light imaging, 64 patients; and linked-color imaging, 71 patients). The pooled adenoma miss rate for electronic chromoendoscopy was not different than white-light endoscopy (17.9% vs 21%; OR, 0.72 (0.67–1.11); I 2 67%; p = 0.13). When only narrow-band imaging, blue-light imaging, and linked-color imaging were considered, the pooled rate was statistically significant (OR, 0.60 (0.37–0.98); p = 0.04). The pooled adenoma detection rate was not statistically different with electronic chromoendoscopy than white-light endoscopy (OR, 1.02 (0.88–1.19); p = 0.78). LIMITATIONS: The small number of studies to assess the impact of each modality limited stratified conclusions. CONCLUSIONS: Electronic chromoendoscopy is not associated with a significant reduction in adenoma miss rate compared with white-light colonoscopy. Abstract : Supplemental Digital Content is available in the text.