Meta-analysis finds Virtual Scale Endoscopy improves colorectal polyp measurement accuracy

BACKGROUND AND AIMS: Accurate polyp measurement is vital for colorectal cancer treatment and surveillance. Traditional methods are often unreliable. The FDA-approved Virtual Scale Endoscopy (VSE) provides real-time, laser-calibrated overlays to improve size measurements. This meta-analysis evaluated the diagnostic accuracy of VSE compared with conventional methods, including visual assessment (VA), snare, and biopsy forceps. METHODS: We conducted a pairwise meta-analysis comparing VSE and VA, along with a frequent network meta-analysis (NMA) assessing VSE, VA, snare, and forceps retrieved from PubMed, Cochrane, Web of Science, Embase, WPRIM, and Scopus until January 2025. Risk ratios (RRs) and mean differences (MDs) were computed with 95% CIs. Surface under the cumulative ranking area (SUCRA) analysis ranked interventions (PROSPERO ID: CRD420251024644). RESULTS: Eleven studies were included, comprising 1581 polyps across 6 clinical and 5 preclinical studies. In pairwise analysis, VSE significantly improved measurement accuracy compared to VA (MD, 14.52%; 95% CI, 10.35-18.70) and reduced total misclassifications (54.3% vs 73.6%; RR, 0.64; 95% CI, 0.42-0.97). In clinical subgroups, VSE markedly reduced overestimation rates (22.5% vs 41.5%; RR, 0.52; 95% CI, 0.44-0.63). NMA confirmed VSE as the top-ranked modality for minimizing total misclassification (SUCRA: 100%), outperforming snare, forceps, and VA. No overall differences were detected in total overestimation or underestimation. CONCLUSIONS: VSE significantly improves polyp sizing accuracy compared with VA, snare, and forceps across both clinical and preclinical settings. NMA supports VSE as the top-ranking modality, suggesting its potential to enhance decision-making in polypectomy and surveillance. Larger multicenter trials are needed for validation.