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DOI: 10.1055/s-0040-1704365
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
Publikationsverlauf
Publikationsdatum:
23. April 2020 (online)
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:
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SD equipment and
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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.
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