Dye-based chromoendoscopy improves detection of colorectal neoplasia: Study

Italy: Dye-based chromoendoscopy (DBC) is effective in increasing adenoma detection rate (ADR) in patients undergoing colonoscopy, thus supporting its use in routine clinical practice, showed meta-analysis of RCTs published in the Gastrointestinal Endoscopy.

Chromoendoscopy is an image-enhanced endoscopic technique that highlights differences in the mucosa, as well as dysplastic and malignant changes that are not apparent in white light. Chromoendoscopy is used to increase the detection rates for various pathologic processes during endoscopy. Dye-based chromoendoscopy, uses topical dyes such as methylene blue or indigo carmine. The main benefit of DBC is its ability to distinguish neoplastic from nonneoplastic lesions during ongoing colonoscopy. The adenoma detection rate (ADR) is the percentage of patients aged ≥50 years undergoing first-time screening colonoscopy who have one or more conventional adenomas detected and removed.

Dye-Based chromoendoscopy (DBC) could be effective in increasing adenoma detection rate (ADR) in patients undergoing colonoscopy, but the technique is time-consuming and its uptake is limited. Giulio Antonelli, "Sapienza" University of Rome, Italy, and colleagues conducted a meta-analysis study to assess the effect of DBC on ADR based on available randomized controlled trials (RCTs).

Investigators searched four databases for RCTs comparing DBC with conventional colonoscopy (CC) in terms of ADR, advanced ADR, and sessile serrated adenoma (SSA) detection rates as well as the mean number of adenomas per patient (MAP) and non-neoplastic lesions. Overall, 10 RCTs (5,334 patients) were included. Indication for colonoscopy was screening or surveillance (3 studies) and mixed (7 studies)

Key findings of the study are as follows,

• Pooled ADR was higher in the DBC group (48.1%) vs. the CC group (39.3%), with low heterogeneity. This effect was consistent for advanced ADR (RR=1.21), and for SSA as well as for MAP, overall, and in the right colon.

• High-definition white-light colonoscopy (HDWL) was more effective than standard white-light colonoscopy (SDWL) for detection of adenomas (51.6% vs. 34.2) and DBC (59.1%) was more effective than HDWL.

The authors conclude that the pooled adenoma detection rate (ADR) was higher in the DBC group than in the CC group. The DBC group also had a higher pooled advanced ADR and sessile serrated adenoma detection rate. DBC was more effective in detecting adenomas than a standard white light colonoscopy and high-definition white light colonoscopy.

Reference:

Antonelli G, Correale L, Spadaccini M, Maselli R, Bhandari P, Bisschops R, Cereatti F, Dekker E, East JE, Iacopini F, Jover R, Kiesslich R, Pellise M, Sharma P, Rex DK, Repici A, Hassan C. Dye-based chromoendoscopy for the detection of colorectal neoplasia: meta-analysis of randomized controlled trials. Gastrointest Endosc. 2022 May 16:S0016-5107(22)01678-9. doi: 10.1016/j.gie.2022.05.002. Epub ahead of print. PMID: 35588768.