Comparative Performance of Image-Enhanced Endoscopy for Adenoma and Sessile Serrated Lesion Detection: A Network Meta-Analysis.

BACKGROUND AND AIMS: Image-enhanced endoscopy (IEE) technologies have been developed to improve colorectal polyp detection, but their comparative efficacy remains uncertain. We performed a network meta-analysis to compare the efficacy of major IEE modalities on colorectal polyp detection.

METHODS

We searched MEDLINE, Embase, and CENTRAL for randomized controlled trials comparing seven IEE modalities (autofluorescence imaging, blue-light imaging, flexible spectral imaging color enhancement, i-scan, linked color imaging [LCI], narrow band imaging [NBI], and texture and color enhancement imaging [TXI]) with white-light imaging (WLI). The primary outcome was the comparison of performance of IEE systems in adenoma detection rate (ADR); the secondary outcome was sessile serrated lesion detection rate (SSLDR). We estimated the number needed to screen (NNS) with 95% credible intervals (CrIs). Study credibility was assessed using the Confidence in Network Meta-analysis (CINeMA) framework.

RESULTS

Fifty-three randomized controlled trials encompassing 34,364 patients were included. Compared with WLI, moderate-confidence evidence supported improvements in ADR with TXI (NNS 13, 95% CrIs 7-32), LCI (NNS 17, 95% CrIs 11-31), and NBI (NNS 35, 95% CrIs 18-139), whereas low-confidence evidence supported benefits for i-scan (NNS 7, 95% CrIs 3-18). Direct comparison across IEEs demonstrated little-to-no clinically meaningful differences in ADR. For SSLDR, moderate-confidence evidence supported improvements with LCI (NNS 29, 95% CrIs 15-96) and NBI (NNS 38, 95% CrIs 19-143) compared with WLI.

CONCLUSIONS

LCI demonstrated the most robust and reproducible performance across multiple analyses with moderate-confidence evidence, although differences among IEE modalities were generally modest.