Endoscopy 2020; 52(S 01): S118
DOI: 10.1055/s-0040-1704365
ESGE Days 2020 oral presentations
Saturday, April 25, 2020 11:00 – 13:00 Finders keepers Liffey Hall 1
© Georg Thieme Verlag KG Stuttgart · New York

DYE-BASED CHROMOENDOSCOPY VERSUS STANDARD-DEFINITION AND HIGH-DEFINITION WHITE-LIGHT ENDOSCOPY FOR ENDOSCOPIC ADENOMA DETECTION IN LYNCH SYNDROME: META-ANALYSIS OF INDIVIDUAL PATIENT DATA FROM RANDOMISED TRIALS

BBSL Houwen
1   Amsterdam University Medical Centre, location Academic Medical Centre, University of Amsterdam, Gastroenterology and Hepatology, Amsterdam, Netherlands
,
NS. Mostafavi
2   Amsterdam University Medical Centre, Location AMC, Academic Medical Centre, University of Amsterdam, Gastroenterology and Hepatology, Subdivision Statistics, Amsterdam, Netherlands
,
JLA Vleugels
1   Amsterdam University Medical Centre, location Academic Medical Centre, University of Amsterdam, Gastroenterology and Hepatology, Amsterdam, Netherlands
,
R Hüneburg
3   University of Bonn, Internal Medicine, Bonn, Germany
4   University Hospital Bonn, National Center for Hereditary Tumor Syndromes, Bonn, Germany
,
C Lamberti
5   Klinikum Coburg, Hematology and Oncology, Coburg, Germany
,
L Rivero-Sánchez
6   Hospital Clinic of Barcelona, Gastroenterology, Barcelona, Spain
,
M Pellisé
6   Hospital Clinic of Barcelona, Gastroenterology, Barcelona, Spain
,
E Stoffel
7   University of Michigan, Internal Medicine, Division of Gastroenterology and Hepatology, Michigan, United States of America
,
S Syngal
8   Brigham and Women’s Hospital, Internal Medicine, Division of Gastroenterology and Hepatology, Boston, United States of America
9   Dana Farber Cancer Institute, Medical Oncology, Division of Cancer Genetics and Prevention, Boston, United States of America
10   Harvard Medical School, Boston, United States of America
,
JF Haanstra
11   University Medical Center Groningen, University of Groningen, Gastroenterology and Hepatology, Groningen, Netherlands
,
JJ Koornstra
11   University Medical Center Groningen, University of Groningen, Gastroenterology and Hepatology, Groningen, Netherlands
,
E Dekker
1   Amsterdam University Medical Centre, location Academic Medical Centre, University of Amsterdam, Gastroenterology and Hepatology, Amsterdam, Netherlands
,
Y Hazewinkel
12   Radboud University Nijmegen Medical Centre, Radboud University of Nijmegen, Gastroenterology and Hepatology, Nijmegen, Netherlands
› Author Affiliations
Further Information

Publication History

Publication Date:
23 April 2020 (online)

Also available at
 

Aims The additional diagnostic value of dye-based chromoendoscopy (CE) compared to standard-definition and high-definition white-light endoscopy (SD-WLE and HD-WLE) for surveillance of Lynch syndrome (LS) patients is subject to debate. To clarify this debate, an individual patient data (IPD) meta-analysis was performed.

Methods Randomised controlled trials (RCTs) comparing the efficacy of dye-based CE to WLE for the detection of adenomas in LS patients (MLH1, MSH2, MSH6, PMS2, EpCAM) were included. The primary outcome was the adenoma detection rate (ADR) (i.e. proportion of patients with at least one adenoma detected during colonoscopy). Patients were subdivided in two groups:

  1. SD equipment and

  2. HD equipment.

Mixed-effect logistic regression models were used to estimate ADR across studies.

Results Two RCTs and one randomised tandem study were included, comprising 533 LS patients with a proven mutation. HD equipment was used in 363/533 (68%) of the procedures. The ADR was 74/265 (28%) in patients randomised to WLE compared to 83/266 (31%) patients randomised to CE (odds ratio [OR] 1.17; 95%CI 0.81-1.70, P=0.41). No difference in ADR was observed for either imaging modality within the HD (OR 1.20, 95%CI 0.77-1.90, P=0.42) or SD equipment subgroup (OR 1.17; 95%CI 0.60-2.32, P=0.65). The mean number of adenomas detected per patient with CE was 0.52 compared to 0.47 with WLE (incidence rate ratio 1.09; 95%CI 0.78-1.52, P=0.60). CE was more time consuming than WLE (mean extubation time CE 19 vs WLE 12 minutes, P< 0.01).

Conclusions In this IPD meta-analysis of RCTs in LS patients, dye-based CE did not improve the ADR or mean number of adenomas detected per patient compared to WLE. As CE was associated with a prolonged procedural time and prior studies showed that HD equipment increases adenoma detection compared to SD equipment, we suggest to use HD-WLE as the preferred image modality for the surveillance of LS patients.