High-definition colonoscopy for improving adenoma detection: a systematic review and meta-analysis of randomized controlled studies

Georgios Tziatzios; Paraskevas Gkolfakis; Lazaros Dimitrios Lazaridis; Antonio Facciorusso; Giulio Antonelli; Cesare Hassan; Alessandro Repici; Prateek Sharma; Douglas K Rex; Konstantinos Triantafyllou

doi:10.1016/j.gie.2019.12.052

High-definition colonoscopy for improving adenoma detection: a systematic review and meta-analysis of randomized controlled studies

Gastrointest Endosc. 2020 May;91(5):1027-1036.e9. doi: 10.1016/j.gie.2019.12.052. Epub 2020 Jan 15.

Affiliations

¹ Hepatogastroenterology Unit, Second Department of Internal Medicine - Propaedeutic, Research Institute and Diabetes Center, Medical School, National and Kapodistrian University of Athens, "Attikon" University General Hospital, Athens, Greece.
² Gastroenterology Unit, Department of Medical Sciences, University of Foggia AOU, Ospedali Riunity Viale Pinto, Foggia, Italy.
³ Endoscopy Unit, Sant'Andrea University Hospital, "Sapienza" University of Rome, Rome, Italy.
⁴ Endoscopy Unit, Nuovo Regina Margherita Hospital, Rome, Italy.
⁵ Digestive Endoscopy Unit, Division of Gastroenterology, Humanitas Clinical and Research Center and Humanitas University, Rozzano, Italy.
⁶ Division of Gastroenterology & Hepatology, Department of Internal Medicine, University of Kansas Medical Center, Kansas, Missouri; Department of Gastroenterology, Veteran Affairs Medical Center, Kansas, Missouri.
⁷ Division of Gastroenterology/Hepatology, Indiana University Hospital, Indianapolis, Indiana, USA.

PMID: 31954133
DOI: 10.1016/j.gie.2019.12.052

Abstract

Background and aims: Previous meta-analysis showed marginal benefit of high-definition white-light endoscopy (HD-WLE) over standard-definition colonoscopy (SDC) for adenoma detection, but with residual uncertainty due to inclusion of nonrandomized studies. We aimed to further assess the effect of HD-WLE on adenoma detection by including only randomized controlled trials (RCTs).

Methods: A literature search was performed for RCTs evaluating HD-WLE versus SDC in terms of adenoma, advanced adenoma, and serrated sessile adenoma detection rates as well as the mean number of adenomas per colonoscopy (MAC), the mean number of advanced adenomas per colonoscopy (MAAC), and the mean number of sessile serrated adenomas per colonoscopy (MSSAC). The effect size on study outcomes is presented as the risk ratio (RR; 95% confidence interval [CI]) or mean difference (MD; 95% CI). We assessed the strength of evidence using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach.

Results: Six RCTs involving 4594 individuals (HD-WLE, 2323; SDC, 2271) were included. Clinical indications were screening (1 study), positive result for fecal occult blood test, personal/family history of colorectal cancer (1 study), and mixed indications (4 studies). Withdrawal time was similar between the 2 arms (MD, -0.06; 95% CI, -0.25 to 0.12; P = .50). The adenoma detection rate was significantly higher in the HD-WLE arm compared with the SDC arm (40% vs 35%; RR, 1.13; 95% CI, 1.05-1.22; P = .001; I² = 0%; GRADE, low). This effect was consistent for advanced and sessile serrated adenoma detection rates (RR, 1.33; 95% CI, 1.03-1.72; P = .03; I² = 0%; GRADE, low; and RR, 1.55; 95% CI, 1.05-2.28; P = .03; I² = 0%; GRADE, low, respectively). In contrast, the difference was not significant for MAC, MAAC, and MSSAC.

Conclusions: Meta-analyses of RCT data support the use of HD-WLE in clinical practice, although the additional benefit is limited.

Publication types

Meta-Analysis
Systematic Review

MeSH terms

Adenoma* / diagnostic imaging
Colonoscopy
Colorectal Neoplasms* / diagnostic imaging
Humans
Odds Ratio