Dye Chromoendoscopy Outperforms High-Definition White Light Endoscopy in Dysplasia Detection for IBD Patients: An Updated Meta-analysis of Randomized Controlled Trials.

OBJECTIVE:Whether dye spray chromoendoscopy (DCE) adds value in surveillance colonoscopy with high-definition (HD) scopes remains controversial. This updated meta-analysis compares dysplasia detection using DCE and high-definition white-light endoscopy (HD-WLE) in patients with inflammatory bowel disease (IBD) undergoing surveillance colonoscopy. METHODS:A comprehensive search was performed for randomized controlled trials (RCTs) comparing HD-WLE and DCE in IBD patients. The primary outcome was to compare the proportion of patients with at least one dysplastic lesion detected by DCE vs. HD-WLE. Odds Ratios (OR) and 95% Confidence Intervals (CI) were pooled using the random effects model, with I2 > 60% indicating substantial heterogeneity. The Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) approach was used to assess the certainty of evidence (CoE). RESULTS:Six RCTs involving 978 patients were analyzed (DCE=479 vs. HD-WLE=499 patients). DCE detected significantly more patients with dysplasia than HD-WLE (18.8% vs. 9.4%), OR = 1.94 (95% CI 1.2-3.1, I2 28%, p=0.006, high CoE). This remained significant after excluding two RCTs published as abstracts. A sensitivity analysis excluding a non-inferiority RCT with a single experienced operator eliminated the results' heterogeneity, OR 2.5 (95% CI: 1.5-3.9, I2=0%). Although high-grade dysplasia detection was numerically higher in the DCE group (2.8% vs. 1.1%), the difference was statistically insignificant, OR 2.2 (95% CI: 0.64-7.6, I2=0%, low CoE). CONCLUSION:Our updated meta-analysis supports DCE as a superior strategy in overall dysplasia detection in IBD, even with HD scopes. When expertise is available, DCE should be considered for surveillance colonoscopy in high-risk IBD patients, with the acknowledgment that virtual chromoendoscopy shows equivalence in recent studies. Further multicenter trials with multiple endoscopists with varying expertise levels and longer-term outcome data showing a reduction in cancer or cancer-related death are needed.