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Impact of Electronic Chromoendoscopy on Adenoma Miss Rates During Colonoscopy

A Systematic Review and Meta-analysis

Desai, Madhav M.D., M.P.H.1; Viswanathan, Lavanya M.D., M.S.2; Gupta, Neil M.D., M.P.H.3; Kennedy, Kevin F. M.S.4; Repici, Alessandro M.D.5; Hassan, Cesare M.D., Ph.D.6; Sharma, Prateek M.D.1,4

doi: 10.1097/DCR.0000000000001419
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BACKGROUND: The impact of virtual chromoendoscopy such as narrow-band imaging, Fujinon intelligent chromoendoscopy, blue-light imaging, linked-color imaging, and i-SCAN on adenoma detection rate has been variable. However, adenoma miss rate (another measure suggested as a quality indicator) of electronic chromoendoscopy modalities has not been systematically evaluated.

OBJECTIVES: This study aimed to perform a systematic review and meta-analysis to examine the adenoma miss rate of white-light endoscopy compared with electronic chromoendoscopy.

DATA SOURCES: Medline, Embase, Scopus, Web of Knowledge, and Cochrane were the data sources for this study.

STUDY SELECTION: The studies selected were tandem randomized controlled trials of electronic chromoendoscopy modalities compared with white-light endoscopy.

INTERVENTIONS: Electronic chromoendoscopy compared with white light endoscopy was used to measure the adenoma miss rate.

MAIN OUTCOME MEASURES: Primary outcome was the pooled adenoma miss rate of electronic chromoendoscopy techniques compared with white-light endoscopy. Secondary outcomes were subgroup analysis, adenoma size analysis, and adenoma detection rate.

RESULTS: A total of 3507 patients were evaluated from 7 eligible tandem randomized control trials. A total of 1423 patients had white-light endoscopy as the first of the tandem examinations. The rest of the patients had electronic chromoendoscopy as the first of the tandem examination (narrow-band imaging, 988 patients; Fujinon intelligent chromoendoscopy, 728 patients; i-SCAN, 233 patients; blue-light imaging, 64 patients; and linked-color imaging, 71 patients). The pooled adenoma miss rate for electronic chromoendoscopy was not different than white-light endoscopy (17.9% vs 21%; OR, 0.72 (0.67–1.11); I2 67%; p = 0.13). When only narrow-band imaging, blue-light imaging, and linked-color imaging were considered, the pooled rate was statistically significant (OR, 0.60 (0.37–0.98); p = 0.04). The pooled adenoma detection rate was not statistically different with electronic chromoendoscopy than white-light endoscopy (OR, 1.02 (0.88–1.19); p = 0.78).

LIMITATIONS: The small number of studies to assess the impact of each modality limited stratified conclusions.

CONCLUSIONS: Electronic chromoendoscopy is not associated with a significant reduction in adenoma miss rate compared with white-light colonoscopy.

1 Division of Gastroenterology & Hepatology, Department of Internal Medicine, University of Kansas Medical Center, Kansas City, Kansas

2 Division of Gastroenterology and Hepatology, Medical College of Georgia, Augusta University, Augusta, Georgia

3 Gastroenterology and Hepatology, Loyola University Medical Center, Chicago, Illinois

4 Department of Gastroenterology, Veteran Affairs Medical Center, Kansas City, Kansas

5 Endoscopy Unit, Humanitas University, Rozzano, Milano, Italy

6 Endoscopy Unit, Nuovo Regina Margherita Hospital, Rome, Italy

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Funding/Support: None reported.

Financial Disclosures: None reported.

Poster presentation at the American Gastroenterological Association Meeting, San Diego, CA, May 21 to 24, 2016.

Correspondence: Prateek Sharma, M.D., Department of Gastroenterology/Hepatology and Motility, University of Kansas Medical Center and Veteran Affairs Medical Center (Kansas City), 3901 Rainbow Blvd Kansas City, KS 66160. E-mail:

© 2019 The American Society of Colon and Rectal Surgeons