title: Chromoendoscopy for Surveillance in Ulcerative Colitis and Crohn's Disease: A Systematic Review of Randomized Trials.
abstract: OBJECTIVE
  Key international guideline agencies recommend dysplasia surveillance in inflammatory bowel diseases with chromoendoscopy. We performed a systematic review of randomized trials comparing chromoendoscopy vs other endoscopic techniques for dysplasia surveillance in inflammatory bowel diseases.
  
  
  METHODS
  We searched MEDLINE, EMBASE, and the Cochrane Central Register of Controlled Trials for relevant studies published through September 2016. We estimated risk ratios (RRs) for dichotomous outcomes (all-cause/colorectal cancer-related mortality, time to interval cancer, patients with dysplasia, total/subtypes of dysplastic lesions, dysplasia detected by targeted biopsies, adverse events), mean differences for continuous outcomes (procedural time, costs, total/targeted biopsies), and their 95% confidence intervals (CIs) using a random-effects model. Subgroup analyses included technique compared with chromoendoscopy, type of disease, and type of dye. We estimated sensitivity and specificity of the techniques with reference to histology.
  
  
  RESULTS
  We identified 10 randomized trials (n = 1500 participants). There was a higher likelihood of detecting patients with dysplasia with chromoendoscopy compared with other techniques (RR, 1.37; 95% CI, 1.04-1.79). Subgroup analyses confirmed this effect only if chromoendoscopy was compared with standard-definition white-light endoscopy (RR, 2.12; 95% CI, 1.15-3.91). Chromoendoscopy required a significantly longer procedural time compared with other techniques (mean difference, 8.91 min; 95% CI, 1.37-16.45). There was no difference in the likelihood of detecting dysplastic subtypes and dysplasia by targeted biopsies between groups. Test sensitivity and specificity were similar between groups.
  
  
  CONCLUSIONS
  In surveillance of inflammatory bowel diseases, chromoendoscopy identifies more patients with dysplasia only when compared with standard-definition white-light endoscopy. It is associated with longer procedural time with no direct evidence of effect on preventing all-cause/cancer-specific mortality or time to interval cancer.
authors.affiliation: Section of Gastroenterology, University of Bari, Bari, Italy. Electronic address: ianan@hotmail.it.
authors.forename: Andrea
authors.initials: A
authors.lastname: Iannone
authors.affiliation: Diaverum Medical Scientific Office, Lund, Sweden; Department of Translational Medicine, Amedeo Avogadro University of Eastern Piedmont, Novara, Italy.
authors.forename: Marinella
authors.initials: M
authors.lastname: Ruospo
authors.affiliation: Sydney School of Public Health, University of Sydney, Australia; Centre for Transplant and Renal Research, Westmead Hospital, Sydney, Australia.
authors.forename: Germaine
authors.initials: G
authors.lastname: Wong
authors.affiliation: Section of Gastroenterology, University of Bari, Bari, Italy.
authors.forename: Mariabeatrice
authors.initials: M
authors.lastname: Principi
authors.affiliation: Section of Gastroenterology, University of Bari, Bari, Italy.
authors.forename: Michele
authors.initials: M
authors.lastname: Barone
authors.affiliation: Diaverum Medical Scientific Office, Lund, Sweden; Sydney School of Public Health, University of Sydney, Australia; Department of Emergency and Organ Transplantation, University of Bari, Bari, Italy; Diaverum Academy, Lund, Sweden.
authors.forename: Giovanni F M
authors.initials: GFM
authors.lastname: Strippoli
authors.affiliation: Section of Gastroenterology, University of Bari, Bari, Italy.
authors.forename: Alfredo
authors.initials: A
authors.lastname: Di Leo
mesh_terms: D003093:Colitis, Ulcerative / Q000150:complications*; D015179:Colorectal Neoplasms / Q000175:diagnosis*; D003424:Crohn Disease / Q000150:complications*; D003955:Diagnostic Tests, Routine / Q000379:methods*; D055088:Early Detection of Cancer / Q000379:methods*; D004724:Endoscopy / Q000379:methods*; D006801:Humans; D016032:Randomized Controlled Trials as Topic; D012680:Sensitivity and Specificity
keywords: NBI; Surveillance; i-SCAN