Network meta-analysis shows image-enhanced endoscopy methods improve adenoma detection rates compared to high-definition white light imaging in colorectal lesion screening.

This study is a network meta-analysis of randomized controlled trials conducted across various settings, encompassing a total population of 28,663 participants. The analysis focused on the use of image-enhanced endoscopy (IEE) methods for the detection of colorectal lesions. The primary comparator was high-definition white light imaging (HD-WLI). The IEE methods evaluated included texture and color enhancement imaging (TXI), linked color imaging (LCI), high-definition white light imaging (HD-WLI) as a baseline, new-generation narrow band imaging (NBI), and blue light imaging. The primary outcomes assessed were the adenoma detection rate (ADR) and the advanced adenoma detection rate. Secondary outcomes included polyp detection rate, sessile serrated lesion detection rate, the mean number of colonic lesions detected per patient, and lesion characterization accuracy measured by area under the curve (AUC).

The results indicated that TXI ranked highest for the adenoma detection rate, with a relative risk (RR) of 1.48 compared to HD-WLI. The 95% confidence interval for this finding was 1.09 to 2.02. When LCI was compared with HD-WLI, it also showed superiority with an RR of 1.23. Regarding advanced adenoma detection, both TXI and LCI demonstrated superiority over HD-WLI, with RRs of 1.42 and 1.23, respectively. In terms of the number of adenomas detected, new-generation NBI ranked highest with a SUCRA value of 82.3%. For overall polyp detection, LCI led with a SUCRA value of 88.4%.

Lesion characterization results showed that new-generation NBI and blue light imaging effectively distinguished adenomas from non-neoplastic lesions. The AUC for new-generation NBI was 0.880, while the AUC for blue light imaging was 0.812. Safety and tolerability data were not reported in the included trials, and no adverse events, serious adverse events, discontinuations, or specific tolerability metrics were available for analysis. The study did not report specific absolute numbers for adverse events or discontinuations.

When comparing these results to prior landmark studies in the therapeutic area of colorectal cancer screening, this network meta-analysis provides a comprehensive ranking of various IEE modalities. The data suggests that specific IEE techniques offer distinct advantages for detecting adenomas and advanced adenomas compared to standard HD-WLI. However, the study highlights that further comparative studies are needed to guide optimal IEE modality selection for colorectal neoplasia, as the evidence varies by specific outcome and modality.

Key methodological limitations include the fact that findings on lesion characterization are based on a limited number of randomized controlled trials. Consequently, these specific findings should be interpreted cautiously. Potential biases related to the heterogeneity of the included trials and the varying definitions of outcomes across studies may influence the overall conclusions. The study notes that the evidence for lesion characterization is particularly weak and requires careful consideration before clinical application.

Clinically, this evidence supports the consideration of TXI and LCI for improving adenoma and advanced adenoma detection rates in patients undergoing colonoscopy. The choice of IEE modality may depend on the specific clinical goal, such as maximizing polyp detection or optimizing lesion characterization. However, practitioners must recognize that the data for lesion characterization is limited. Questions remain regarding the long-term impact of these detection rates on cancer incidence and mortality, as well as the cost-effectiveness of adopting specific IEE technologies over standard HD-WLI.

In summary, while IEE methods generally outperform HD-WLI for adenoma detection, the evidence is not uniform across all modalities or outcomes. Clinicians should interpret the lesion characterization findings with caution due to the small number of contributing trials. The overall certainty of the evidence for lesion characterization is low, and further research is required to solidify recommendations for routine use of specific IEE technologies in colorectal screening programs.