Comparative Efficacy and Safety of Endoscopic Modalities for Colorectal Cancer Screening in Inflammatory Bowel Disease: A Systematic Review and Network Meta-Analysis

Background & Aims: Long-standing inflammatory bowel disease (IBD) increases the risk of colonic neoplasia, necessitating effective screening strategies. This network meta-analysis compared the efficacy and safety between different endoscopic modalities in the high-definition (HD) era. Methods: We searched CENTRAL, ClinicalTrials.gov, Embase, MEDLINE, and WHO for randomized controlled trials (RCTs) comparing endoscopic modalities for screening colonoscopy in patients with IBD up to February 2024. The primary outcome was detection of any dysplastic lesion per patient. The certainty of the evidence was GRADE-assessed. Results: A total of 26 RCTs involving 4159 participants were included, comparing 6 endoscopic modalities: HD white light endoscopy (HD-WLE), HD virtual chromoendoscopy (HD-VCE), HD dye-based chromoendoscopy (HD-DCE), HD-WLE with segmental re-inspection (SR), auto-fluorescence imaging (AFI), and full-spectrum endoscopy (FUSE). HD-DCE may have a small benefit in detecting dysplasia over HD-WLE (low certainty, small magnitude;: relative risk [RR], 1.42; 95% confidence interval [CI], 1.02–1.98). FUSE may be no different to HD-WLE (low certainty: RR, 3.24; 95% CI, 0.66–15.87). The other modalities were assessed as very low certainty (HD-WLE with SR: RR, 1.35; 95% CI, 0.66–2.77; AFI: RR, 1.18; 95% CI, 0.55–2.57; HD-VCE: RR, 0.99; 95% CI, 0.69–1.43). Sensitivity analyses supported these findings. Limited data on serious adverse events precluded meta-analysis; 2 serious events were reported among 2164 patients (very low certainty). Conclusions: HD-DCE is the only modality for IBD surveillance with evidence (low-certainty) demonstrating potential to detect more dysplastic lesions compared with HD-WLE. There was no evidence to support any of the other modalities as an alternative due to very low-certainty evidence.