Benefit of chromoendoscopy requires more evidence, expert says
WASHINGTON — A meta-analysis of randomized and non-randomized trials showed mixed results when comparing the efficacy of dye-based chromoendoscopy and high definition white light endoscopy, according to a presentation given at Digestive Disease Week.
Shana Rakowsky, MD, of Beth Israel Deaconess Medical Center, said that further randomized controlled trials are needed to determine the best method to identify dysplasia in patients with ulcerative colitis.
Rakowsky said despite a standardized procedure of taking a recommended number of biopsies, the overall sample coverage of the colonic surface is still very small.
“Given this limitation, there’s been a lot of effort to figure out ways to improve our screening colonoscopy techniques,” she said. “As the use of chromoendoscopy has increased, there has been a number of limitations to chromoendoscopy and questions about chromoendoscopy and its proper use.”
Rakowsky and colleagues conducted a systematic review of literature that included randomized controlled trials and observational studies that evaluated standard definition white light endoscopy (SDWLE) or high definition white light endoscopy (HDWLE) compared with chromoendoscopy. The primary outcome of the review was number of patients in whom dysplasia was identified using a per-patient analysis in randomized controlled trials and analyzed separately for observational studies.
The investigators found three randomized controlled trials that compared chromoendoscopy to SDWLE and three that compared chromoendoscopy to HDWLE. They found that chromoendoscopy was more effective in identifying dysplasia than SDWLE (RR = 2.12; 95% CI, 1.15-2.18), but not when compared with HDWLE (RR= 1.36; 95% CI, 0.84-2.18).
Additionally, the researchers found that chromoendoscopy was more effective compared with SDWLE in four observational studies (RR= 3.52; 95% CI, 1.38-8.99), and it was more effective than HDWLE when compared in five other observational studies (RR = 3.15; 95% CI, 1.62-6.13).
“There is a lack of studies looking at high definition endoscopy, which is largely what we use today compared to chromoendoscopy,” Rakowsky said. “There should be ongoing randomized controlled trials looking at comparisons between chromoendoscopy and now, high definition white light endoscopy determining the optimal way to screen our inflammatory bowel disease patients.” – by Alex Young
Feuerstein JD, et al. Abstract 163. Presented at: Digestive Disease Week; June 2-5, 2018; Washington, D.C.
Disclosures: Rakowsky reports no relevant financial disclosures. Please see the DDW faculty disclosure index for a list of all other authors’ relevant financial disclosures.