Colonic lesion characterization in inflammatory bowel disease:A systematic review and meta-analysis  

作　　者：Richard Lord Nicholas E Burr Noor Mohammed Venkataraman Subramanian 

机构地区：[1]Department of Gastroenterology,Leeds Teaching Hospitals NHS Trust,Leeds LS97TF,United Kingdom [2]University of Leeds,Leeds Institute of Biomedical and Clinical Sciences,Leeds LS97TF,United Kingdom

出　　处：《World Journal of Gastroenterology》2018年第10期1167-1180,共14页世界胃肠病学杂志（英文版）

摘　　要：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 nonmagnified 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.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 nonmagnified 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.

关 键 词：Inflammatory bowel disease DYSPLASIA LESION CHARACTERIZATION Confocal laser ENDOMICROSCOPY Narrow band imaging I-scan Fujinon intelligence CHROMOENDOSCOPY 

分 类 号：R57[医药卫生—消化系统]