Comparison of endoscopic dysplasia detection techniques in patients with ulcerative colitis: A systematic review and network meta-analysis

Background: We assessed the comparative efficacy of different dysplasia detection techniques in patients with ulcerative colitis (UC) through a network meta-analysis and rated the quality of evidence using GRADE approach. Methods: Through a systematic literature review of multiple databases through June 30, 2017, we identified parallel-group randomized controlled trials (RCTs) in adults with long-standing UC undergoing surveillance colonoscopy with standard definition-white light endoscopy (SD-WLE), high-definition WLE (HD-WLE), narrow band imaging (NBI), or dye-based chromoendoscopy. The primary outcome was the total number of dysplastic lesions. Pairwise and network meta-analysis was performed; ranking was assessed using surface under the cumulative ranking (SUCRA) probabilities. Results: Based on 8 parallel-group RCTs (924 patients), low-quality evidence supports chromoendoscopy over SD-WLE (odds ratio [OR], 2.37; 95% credible interval [CrI], 0.81-6.94) for any dysplasia detection, whereas very low-quality evidence supports using HD-WLE or NBI over SD-WLE (HD-WLE [vs SD-WLE]: OR, 1.21; 95% CrI, 0.30-4.85; NBI: OR, 1.68; 95% CrI, 0.54-5.22). Very low-quality evidence from indirect comparative analysis supports the use of chromoendoscopy over HD-WLE (OR, 1.96; 95% CrI, 0.72-5.34) or NBI (OR, 1.41; 95% CrI, 0.70-2.84) for any dysplasia detection. The number of patients with advanced neoplasia was very small, precluding meaningful analysis. Conclusions: Although we did not find any single technique to be superior, chromoendoscopy is probably more effective than SD-WLE for detecting any dysplasia, and there is low confidence in estimates supporting its use over HD-WLE or NBI. There is very low-quality evidence to inform the comparative efficacy of these interventions in detecting advanced neoplasia or preventing future colorectal cancer. Pragmatic, parallel- group RCTs with longitudinal follow-up are warranted to inform optimal dysplasia surveillance techniques.