A Systematic Review and Meta-Analysis of Endoscopic Surveillance Studies for Detecting Dysplasia in Patients With Inflammatory Bowel Disease

Inflammatory bowel disease (IBD)is an extremely common gastrointestinal disorder that can give rise to dysplasia and colorectal cancer (CRC). There are various diagnostic methods but endoscopy has proved to be the best in the diagnosis, monitoring, and treatment of IBD. The objective of this review is to evaluate the efficacy of endoscopy in detecting patients with IBD. A structured search strategy on PubMed, Science Direct, and Google Scholar was used, as well as formal inclusion or exclusion, data extraction, validity assessment, and meta-analysis. RevMan 5.4 (Review Manager (RevMan) (Computer program). Version 5.4. The Cochrane Collaboration, 2020) was used for the meta-analysis, and forest plots were generated for each outcome separately. All of these studies are prospective cohorts and 11 of these are randomized controlled trials (RCTs). In IBD, both chromoendoscopy and white light endoscopy are useful in detecting dysplasia and neoplastic lesions. Furthermore, narrow-band imaging is a less time-consuming option for endoscopic surveillance. The meta-analysis also showed that chromoendoscopy is superior to other methods.


Introduction And Background
Gastrointestinal disorders are very common in the present population and inflammatory bowel disease (IBD) is one of them.Many people are affected by it every year [1].Previously, many methods were used for the diagnosis but with the advent of science and technology, endoscopic techniques are widely in use.It is also an effective way of treatment monitoring because multiple treatment and management modalities can be evaluated by endoscopy [2,3].To reflect the term mucosal examination and their walls, endoscopic techniques have proved to be the best.This is the gold standard and helps in determining the type and severity of IBD.This characterization helps in deciding the treatment plan for the disease [4,5].Endoscopy, in conjunction with imaging, can also contribute to achieving the suspension of the disease.It is done by endoscopic measures known as mucosal healing (MH) or endoscopic remission (ER).By doing this, a focal area is targeted.It produces positive, long-lasting results [6,7].Numerous meta-analyses have verified the remarkable results following MH treatment [8,9].In addition to imaging and treatment, it can be used to prevent colorectal cancer (CRC) and dysplasia.The gold standard for endoscopic dysplasia detection in inflammatory bowel disease (IBD) is chromoendoscopy (CE).In CE, specific dyes are injected to enhance the visibility of the intestinal mucosal [10,11].Different endoscopic tools are being used for the evaluation of disease [12].Different methods are also being used to evaluate the staging of disease [12][13][14][15].The purpose of this systematic review and meta-analysis is to assess how well endoscopic techniques and surveillance work for dysplasia detection.

Search Strategy
All studies with endoscopic surveillance in dysplasia were searched.Different studies from peer-reviewed articles were studied and different qualitative and quantitative analyses were measured.All the searches were performed according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.Study selection and data extraction were also done in accordance with PRISMA and

Eligibility Criteria
The review focuses on selecting studies that are very critical for understanding the endoscopic surveillance in patients with IBD having more emphasis on ulcerative colitis and Crohn's disease and the use of various techniques and guidelines for identification and management of dyslapsia.We prioritize research published in peer-reviewed journals and available in full text, ensuring the highest standard of evidence is included in our analysis.Conversely, we exclude studies that do not directly contribute to the objective of our review, including those not peer-reviewed, lacking in data, published in languages other than English, or involving child participants exclusively.
For a detailed breakdown of the inclusion and exclusion criteria employed in our review, see Table 2.

Inclusion Criteria Exclusion Criteria
The study included patients with inflammatory bowel disease (IBD),

Search Strategy
The research plan comprises a systematic and comprehensive search for pertinent literature regarding blog interventions' impact on mental health outcomes.Electronic databases, such as PubMed, Google Scholar, and Web of Science, are searched using a combination of keywords and MeSH terms.Boolean operators (AND, OR) are used to refine the strategy and add synonyms and variations of these terms to the search.To limit the results to human-subject studies published in peer-reviewed journals, search filters are used.In addition, references to pertinent articles and gray literature are manually searched in order to find possible studies that might have been overlooked by electronic searches."Inflammatory bowel disease" OR "Crohn's disease" OR "Ulcerative colitis") AND "endoscopic surveillance" OR "colonoscopy" OR "endoscopy") AND "dysplasia detection" OR "meta-analysis" OR "systematic review") AND "clinical trial" OR "randomized controlled trial" was the search strategy that was employed.

Selection Process
The articles were screened twice.This review generated a list of potential papers.In the second stage of screening, the full text of the articles was used.
For each eligible paper, uniform data extraction tables were tabulated.Any disagreements were resolved through discussion with the final decision by the senior author.The meta-analyses were chosen because their outcome measures were similar.This meta-analysis excluded studies that did not have enough similar data or had poor methodological quality.

Data Collection
We searched peer-reviewed journals and publications for literature that met the inclusion criteria.To reduce the risk of publication bias, peer-reviewed journals were investigated after a thorough review of the literature.Based on the inclusion and exclusion criteria, we worked to "include" or "exclude" eligible studies.
For the final review and analysis, 68 studies were considered.Studies that failed to meet the screening criteria were labeled "exclusion" or "dispute."Before excluding a study from the literature, exclusion reasons were presented.It was occasionally the result of a combination of several exclusionary factors.

Data Items
Searching PubMed, Science Direct, and Google Scholar yielded all articles evaluating endoscopic surveillance for dysplasia detection.For statistical analysis, RevMan 5.4 software (Review Manager (RevMan) (Computer program).Version 5.4.The Cochrane Collaboration, 2020) was used.One hundred fifty-four articles were extracted after extensive research across all databases.The number of studies was reduced to 88 after duplicates were removed.This screening includes removing review articles as well as articles unrelated to the study.Seventeen studies were included in the systematic review and meta-analysis (Figure 1).

FIGURE 1: PRISMA flowchart of the studies included
Articles were excluded based on eligibility criteria.Other systematic reviews and meta-analyses were not part of the review.Studies with irrelevant or wrong study outcomes were excluded.The predetermined eligibility criterion, which might have included elements like study designs, participants' criteria, intervention type, outcome measures, and publication date was used to exclude articles.Additional systematic reviews and meta-analyses were excluded from this review to keep the focus on original research studies.To ensure the accuracy and relevance of the results, studies with irrelevant or incorrect outcomes that did not align with the review's objective were also excluded.

Study Characteristics
The final sample for the systematic analysis included 17 peer-reviewed studies.Table 3 contains a summary of the characteristics and demographic information of the included trials.

Measures Results
Leong et al.

Meta-Analysis
This study gathered data from various research studies.Mean, standard deviations, events, and total were extracted for each variable.When these specific data were unavailable, the means and standard deviations of the intervention and control groups' outcome measurements were used as a substitute.Every trial with relevant outcome data was included, and primary analyses were performed for each score.RevMan 5.4 from the Cochrane database was used.

White Light Endoscopy vs Chromoendoscopy
A Forest plot was created for each of the seven different studies to collect dichotomous data.A fixed-effects model was used with the Mantel-Haenszel test.The horizontal axis was used to calculate the CI (CI=95%), and the plot's "point estimation" was represented by green squares.The vertical line in the center indicates "no effect."The result was d=1.36,CI=95% (1.06, 1.75).Chi 2 =17.85, df=6 (p-value=0.007), and I2=66% were the calculated heterogeneities.The overall effect was determined to be Z=2.40 (p=0.02) after analysis.Individual effects in each study favored the chromoendoscopy group (Figure 3).To evaluate the overall effectiveness of endoscopic surveillance in identifying dysplasia in patients with IBD, our study combined data from several studies.When compared to non-surveillance or less intensive surveillance approaches, we discovered that endoscopic surveillance was linked to a significantly higher detection rate of dysplasia.These results support earlier studies that have suggested the importance of routine endoscopic monitoring in the treatment of IBD patients, especially in detecting dysplasia early on when it may be curable.According to the findings of the systematic review, endoscopy is superior in detecting dysplasia in patients with IBD.In the context of IBD, both chromoendoscopy and white light endoscopy have been shown to be effective in detecting dysplasia and neoplastic lesions.Furthermore, the incorporation of narrow-band imaging in endoscopic surveillance provides an additional, albeit less timeconsuming option.However, it is noted that its effectiveness is lower than that of other endoscopic methods.Our meta-analysis's findings have significant clinical ramifications for how IBD patients are treated.Through endoscopic surveillance, dysplasia can be identified early and treated promptly, potentially improving patient outcomes and lowering mortality.Furthermore, our results corroborate the current guidelines for routine endoscopic surveillance in high-risk groups, including individuals with a history of dysplasia or long-standing, extensive colonic disease.This comprehensive analysis contributes to the optimization of clinical practices and future research in this domain by providing valuable insights into the comparative efficacy and efficiency of different endoscopic approaches for dysplasia detection in IBD.Compared to CE, WLE detects fewer non-polypoid dysplastic lesions.The use of CE in patients with IBD is required in clinical trials, and it is preferable to add the magnification technique to improve the detection rate [33].According to another review, RCTs compared CE to HD-WLE rather than HD-WLE to CE. Dedicated studies to compare the accuracy of CE versus high-definition endoscopy will almost certainly be conducted shortly.Importantly, the noninferiority of HD-WLE to CE has already been reported [34].Another review by Gondal et al. found that high-definition (HD) imaging was superior to detecting dysplasia in ulcerative colitis (UC) patients regardless of the image-enhancing modality used.Notably, current colorectal cancer surveillance guidelines for UC patients show that HD consistently outperforms other options for dysplasia detection.The study emphasizes the uncertainty about the best modality for surveillance colonoscopies in UC, but it strongly advocates for the use of HD, claiming its superiority over white light standard definition, which was identified as the least effective option.The study recommends increased dysplasia detection rates and targeted biopsies, highlighting the potential for improved dysplasia detection rates and targeted biopsies [35].The most popular method for visually evaluating colon lesions is white light endoscopy; however, it is not as good at improving the visualization of surface and vessel patterns.Also known as chromoendoscopy, the colon is sprayed with chemical dyes to achieve greater contrast outcomes compared to WL imaging [36].
All the 17 studies included in this systematic review and meta-analysis are prospective and 11 are RCTs.The limitations noted in this review are: variability in study designs, such as differences in patient populations and surveillance protocols, introduces heterogeneity in the results synthesis.Concerns have been raised about the representation of studies with positive or statistically significant findings due to the possibility of publication bias.The incompatibility of data reporting, variations in endoscopic techniques, and variations in dysplasia definitions among studies exacerbate the challenge of comparing and generalizing results.Future investigations in this field ought to focus on resolving the constraints noted in our analysis and providing more clarification on the best practices for endoscopic monitoring of IBD patients.Larger sample sizes and standardized surveillance protocols in longitudinal studies are required to confirm our results and offer stronger evidence for clinical decision-making.Furthermore, the creation and assessment of innovative endoscopic methods, like chromoendoscopy and sophisticated imaging modalities, may improve dysplasia detection.
, Intervention, Comparison, Outcome) criteria ( compared to conventional forward-viewing colonoscopy, panorama views obtained by full-spectrum endoscopy were found to increase the number of dysplastic lesions detected in IBD patients undergoing of samples must be examined in order to improve consistency in the diagnosis and grading of IBDterms of dysplasia detection, HD-CE outperforms HD-WLE.2024 Virk et al.Cureus 16(4): e58005.DOI 10.7759/cureus.endoscopically,CGE does not improve the detection of IN in patients with longstanding UC who do not have primary sclerosing cholangitis or a history of IN.CGE takes longer than CC, but it reduces the number of biopsies performed and significantly increases the IN per biopsy yield.Endomicroscopy is a trustworthy method of detecting IN. patients, ESD achieves curative resections, but the procedure is difficult due to the high prevalence of submucosal fibrosis.neoplasia by HDV and HDWL was not significantly different.During a targeted biopsy or resection, almost all neoplasia was discovered.Nontargeted biopsies do not provide any additional benefit.do not detect colitis-associated neoplasia in the same way.NBI may eventually replace traditional CE due to its longer withdrawal time and ease of use.neoplasia detection in ulcerative colitis patients while reducing the yield of random biopsies.The pit pattern NBI analysis predicts histology with moderate accuracy, whereas AFI color appears useful in ruling out the presence of neoplasia.recommended as a standard technique due to the high rates of NBI lesions and patient misses.vivo histology can determine whether UC lesions identified by chromoscopy should be biopsied, increasing diagnostic yield, and reducing the number of biopsy examinations required.Picco et al. produced high levels of interobserver agreement for polyp detection, acceptable withdrawal times, and improved dysplasia detection in UC surveillance.These findings are encouraging for the implementation of chronic UC CE programs.2024 Virk et al.Cureus 16(4): e58005.DOI 10.7759/cureus.detection of dysplastic lesions during surveillance endoscopy in patients with long-standing UC and should be used in these patients.than WLE in detection but not less effective.