EFFICACY OF DYE-BASED CHROMOENDOSCOPY FOR COLORECTAL NEOPLASIA DETECTION: A SYSTEMATIC REVIEW AND METANALYSIS

Aims Dye-Based chromoendoscopy (DBC) has shown to be effective in increasing adenoma detection rate (ADR), but the technique is time-consuming and its uptake is limited. The burden of dye spraying the colon has recently been cut down by the possibility to orally administer the dye during bowel preparation. We aimed to assess the effect of DBC in increasing ADR including only randomized controlled trials (RCTs).

Methods Four scientific databases were searched for RCTs comparing DBC with standard colonoscopy (SC) in terms of ADR, advanced ADR, and serrated sessile adenoma detection rates as well as the mean number of adenomas per patient (MAP) and per colonoscopy (MAC) and the mean number of sessile serrated adenomas per colonoscopy (MSSAC). We calculated relative risk (RR) and 95% confidence intervals (CIs), using a random-effect model. The I² test was used for quantifying heterogeneity. Quality of the studies was evaluated with GRADE system.

Results Overall, 10 RCTs (5,334 patients; 2,650 DBC, 2,684 SC) were included. Indication for colonoscopy was screening/surveillance (3 studies), mixed (5 studies) and high-risk patients (2 studies) Procedure time was increased in the DBC arm (27.6 vs 20.9 mins; p=<0.001). Pooled ADR was higher in the DBC group vs. SC group, (48.2% [41.8-54.6%] vs 39.8% [33.9-46.2%]; RR=1.20 [95%CI 1.11- 1.29], p<0.00001), with low heterogeneity (I²=29%). This effect was consistent for advanced ADR (RR=1.21 [95% CI 1.03-1.42] I2=0.0%), and for MAP (RR 0.24 [95% CI, 0.17–0.31]).

Conclusions Meta-analysis of RCTs supports that DBC increases key-quality parameters in colonoscopy, promoting its incorporation in clinical practice.

Publication History

Article published online:
14 April 2022