Meta-Analysis
Copyright ©The Author(s) 2018. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Mar 14, 2018; 24(10): 1167-1180
Published online Mar 14, 2018. doi: 10.3748/wjg.v24.i10.1167
Colonic lesion characterization in inflammatory bowel disease: A systematic review and meta-analysis
Richard Lord, Nicholas E Burr, Noor Mohammed, Venkataraman Subramanian
Richard Lord, Nicholas E Burr, Noor Mohammed, Venkataraman Subramanian, Department of Gastroenterology, Leeds Teaching Hospitals NHS Trust, Leeds LS97TF, United Kingdom
Richard Lord, Nicholas E Burr, Venkataraman Subramanian, University of Leeds, Leeds Institute of Biomedical and Clinical Sciences, Leeds LS97TF, United Kingdom
Author contributions: Subramanian V envisaged and designed the research; Subramanian V performed the statistical analysis; Lord R wrote the paper and did the information searching; Lord R and Burr NE performed the Selection of papers and data abstraction; Lord R and Mohammed N performed the study quality analysis; all authors have reviewed the manuscript.
Conflict-of-interest statement: The authors deny any conflict of interest.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Venkataraman Subramanian, CCST, MBBS, MD, MRCP, Assistant Professor, Department of gastroenterology, Leeds Teaching Hospitals NHS Trust, Beckett St, Leeds LS97TF, United Kingdom. v.subramanian@leeds.ac.uk
Telephone: +44-113-2068691 Fax: +44-113-2068688
Received: January 8, 2018
Peer-review started: January 9, 2018
First decision: February 5, 2018
Revised: February 18, 2018
Accepted: February 15, 2018
Article in press: February 15, 2018
Published online: March 14, 2018
Processing time: 63 Days and 15.3 Hours
Abstract
AIM

To perform a systematic review and meta-analysis for the diagnostic accuracy of in vivo lesion characterization in colonic inflammatory bowel disease (IBD), using optical imaging techniques, including virtual chromoendoscopy (VCE), dye-based chromoendoscopy (DBC), magnification endoscopy and confocal laser endomicroscopy (CLE).

METHODS

We searched Medline, Embase and the Cochrane library. We performed a bivariate meta-analysis to calculate the pooled estimate sensitivities, specificities, positive and negative likelihood ratios (+LHR, -LHR), diagnostic odds ratios (DOR), and area under the SROC curve (AUSROC) for each technology group. A subgroup analysis was performed to investigate differences in real-time non-magnified Kudo pit patterns (with VCE and DBC) and real-time CLE.

RESULTS

We included 22 studies [1491 patients; 4674 polyps, of which 539 (11.5%) were neoplastic]. Real-time CLE had a pooled sensitivity of 91% (95%CI: 66%-98%), specificity of 97% (95%CI: 94%-98%), and an AUSROC of 0.98 (95%CI: 0.97-0.99). Magnification endoscopy had a pooled sensitivity of 90% (95%CI: 77%-96%) and specificity of 87% (95%CI: 81%-91%). VCE had a pooled sensitivity of 86% (95%CI: 62%-95%) and specificity of 87% (95%CI: 72%-95%). DBC had a pooled sensitivity of 67% (95%CI: 44%-84%) and specificity of 86% (95%CI: 72%-94%).

CONCLUSION

Real-time CLE is a highly accurate technology for differentiating neoplastic from non-neoplastic lesions in patients with colonic IBD. However, most CLE studies were performed by single expert users within tertiary centres, potentially confounding these results.

Keywords: Inflammatory bowel disease dysplasia; Lesion characterization; Confocal laser endomicroscopy; Narrow band imaging; I-scan; Fujinon intelligence chromoendoscopy

Core tip:In vivo lesion characterization in colonic inflammatory bowel disease presents many challenges. Lesions tend to be morphologically different and potentially associated with surrounding/overlying inflammation, obscuring the pit pattern. The ability to accurately characterize lesions in vivo could reduce costs and complications by decreasing the need for polypectomies. Virtual chromoendoscopy (VCE) and dye-based chromoendoscopy currently cannot be recommended for lesion characterization. Confocal laser endomicroscopy is an accurate technology at differentiating neoplastic from non-neoplastic lesions but studies within this meta-analysis involved single expert center with single advanced endoscopic operators, reducing its generalizability. Larger studies are required specifically looking at lesion characterization, especially with rapid technological advancements in VCE (Narrow band imaging, i-scan, Fujinon intelligence chromoendoscopy).