BACKGROUND AND AIMS Previous meta-analysis showed marginal benefit of high-definition white-light endoscopy (HD-WLE) over standard-definition colonoscopy (SDC) for adenoma detection, but with residual uncertainty due to inclusion of nonrandomized studies. We aimed to further assess the effect of HD-WLE on adenoma detection by including only randomized controlled trials (RCTs). METHODS A literature search was performed for RCTs evaluating HD-WLE versus SDC in terms of adenoma, advanced adenoma, and serrated sessile adenoma detection rates as well as the mean number of adenomas per colonoscopy (MAC), the mean number of advanced adenomas per colonoscopy (MAAC), and the mean number of sessile serrated adenomas per colonoscopy (MSSAC). The effect size on study outcomes is presented as the risk ratio (RR; 95% confidence interval [CI]) or mean difference (MD; 95% CI). We assessed the strength of evidence using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. RESULTS Six RCTs involving 4594 individuals (HD-WLE, 2323; SDC, 2271) were included. Clinical indications were screening (1 study), positive result for fecal occult blood test, personal/family history of colorectal cancer (1 study), and mixed indications (4 studies). Withdrawal time was similar between the 2 arms (MD, -0.06; 95% CI, -0.25 to 0.12; P = .50). The adenoma detection rate was significantly higher in the HD-WLE arm compared with the SDC arm (40% vs 35%; RR, 1.13; 95% CI, 1.05-1.22; P = .001; I2 = 0%; GRADE, low). This effect was consistent for advanced and sessile serrated adenoma detection rates (RR, 1.33; 95% CI, 1.03-1.72; P = .03; I2 = 0%; GRADE, low; and RR, 1.55; 95% CI, 1.05-2.28; P = .03; I2 = 0%; GRADE, low, respectively). In contrast, the difference was not significant for MAC, MAAC, and MSSAC. CONCLUSIONS Meta-analyses of RCT data support the use of HD-WLE in clinical practice, although the additional benefit is limited.

中文翻译：

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高清晰度结肠镜检查可改善腺瘤的检测：随机对照研究的系统评价和荟萃分析。

背景和目的先前的荟萃分析显示，用于腺瘤检测的高清晰度白光内窥镜检查（HD-WLE）优于标准清晰度结肠镜检查（SDC），但由于纳入了非随机研究而具有不确定性。我们旨在通过仅纳入随机对照试验（RCT）进一步评估HD-WLE对腺瘤检测的影响。方法进行了文献检索以评估HD-WLE与SDC在腺瘤，晚期腺瘤和锯齿状无蒂腺瘤的检出率以及每例结肠镜检查（MAC）腺瘤的平均数，每例结肠镜检查的晚期腺瘤的平均数（MAAC），以及每个结肠镜检查中无柄锯齿状腺瘤的平均数量（MSSAC）。研究结果的影响大小以风险比（RR; 95％置信区间[CI]）或均值差（MD； 95％CI）。我们使用“建议评估，制定和评估分级”（GRADE）方法评估了证据的强度。结果纳入了6个RCT，涉及4594人（HD-WLE，2323； SDC，2271）。临床指征为筛查（1项研究），粪便潜血试验阳性结果，大肠癌的个人/家族史（1项研究）和混合指征（4项研究）。两组的撤药时间相似（MD，-0.06； 95％CI，-0.25至0.12； P = 0.50）。HD-WLE组的腺瘤检出率明显高于SDC组（40％vs 35％; RR，1.13; 95％CI，1.05-1.22; P = .001; I2 = 0％; GRADE，低）。对于晚期和无柄锯齿状腺瘤检出率，这种效果是一致的（RR，1.33； 95％CI，1.03-1.72； P = .03； I2 = 0％；等级，低；和RR，1.55；95％CI，1.05-2.28；P = 0.03；I2 = 0％；等级，分别为低）。相反，对于MAC，MAAC和MSSAC，差异并不明显。结论RCT数据的荟萃分析支持HD-WLE在临床实践中的使用，尽管附加收益有限。