Comparing endoscopic interventions to improve serrated adenoma detection rates during colonoscopy: a systematic review and network meta-analysis of randomized controlled trials.

Abstract:

OBJECTIVE:Serrated lesions (sessile serrated adenomas/polyps and traditional serrated adenomas) owing to their subtle appearance and proximal location have a high miss rate. The objective of this study is to compare all the available endoscopic interventions for improving serrated adenoma detection rate (SADR) through a network meta-analysis. METHODS:We conducted a systematic review of the available literature (PubMed, Embase, Cochrane and WoS) from inception to 29 November 2019 to identify all the relevant randomized controlled trials. A total of 28 trials with 22 830 patients were included. The studies compared the efficacy of add-on devices (endocap, endocuff, endocuff vision, G-EYE, endorings, AmplifEYE), electronic chromoendoscopy (linked-color imaging, blue laser imaging, narrow band imaging), dye-based chromoendoscopy, full-spectrum endoscopy (FUSE) and water-based techniques (WBT) with each other or high-definition colonoscopy. Both pairwise and network meta-analysis was conducted using the random-effects model. Risk ratios (RR) with 95% confidence intervals (CI) and P-values were calculated. RESULTS:Direct meta-analysis demonstrated superiority for WBT (RR: 1.41, CI: 1.01-1.98), add-on devices (RR: 1.53, CI: 1.13-2.08), narrow band imaging (RR: 1.93, CI: 1.12-3.32) and endocuff vision (RR: 1.87, CI: 1.13-3.11) compared to high-definition colonoscopy. The results were consistent on network meta-analysis with chromoendoscopy as an additional modality for improving SADR (RR: 1.74, CI: 1.03-2.93). CONCLUSION:In a network meta-analysis, add-on devices (particularly endocuff vision), narrow band imaging, WBT and chromoendoscopy were comparable to each other and improved SADR compared to high-definition colonoscopy.

authors

Aziz M,Fatima R,Lee-Smith W,Khuder S,Nawras A

doi

10.1097/MEG.0000000000001844

subject

Has Abstract

pub_date

2020-10-01 00:00:00

pages

1284-1292

issue

10

eissn

0954-691X

issn

1473-5687

journal_volume

32

pub_type

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