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.

中文翻译：

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染料色素内窥镜在 IBD 患者的不典型增生检测中优于高清白光内窥镜：随机对照试验的更新荟萃分析。

目的 染料喷雾色素内窥镜 (DCE) 是否在高清 (HD) 镜监视结肠镜检查中增加价值仍存在争议。这项更新的荟萃分析比较了使用 DCE 和高清白光内窥镜检查 (HD-WLE) 对接受监测结肠镜检查的炎症性肠病 (IBD) 患者进行的不典型增生检测。方法 对 IBD 患者中比较 HD-WLE 和 DCE 的随机对照试验 (RCT) 进行了全面检索。主要结果是比较 DCE 与 HD-WLE 检测到的至少一个发育不良病变的患者比例。使用随机效应模型汇总优势比 (OR) 和 95% 置信区间 (CI)，其中 I2 > 60% 表明存在显着异质性。建议、评估、制定和评价分级 (GRADE) 方法用于评估证据的确定性 (CoE)。结果 分析了涉及 978 名患者的 6 项随机对照试验（DCE=479 例 vs. HD-WLE=499 例患者）。DCE 检测到的不典型增生患者明显多于 HD-WLE（18.8% vs. 9.4%），OR = 1.94（95% CI 1.2-3.1，I2 28%，p=0.006，高 CoE）。在排除两项作为摘要发表的随机对照试验后，这一点仍然很重要。排除由一位经验丰富的操作员进行的非劣效性 RCT 的敏感性分析消除了结果的异质性，OR 2.5（95% CI：1.5-3.9，I2=0%）。尽管 DCE 组的高度不典型增生检出率较高（2.8% vs. 1.1%），但差异在统计学上不显着，OR 2.2（95% CI：0.64-7.6，I2=0%，低 CoE）。结论 我们更新的荟萃分析支持 DCE 作为 IBD 整体不典型增生检测的优越策略，即使使用 HD 镜也是如此。当有专业知识时，应考虑使用 DCE 对高危 IBD 患者进行结肠镜监测，并承认虚拟色素内窥镜检查在最近的研究中显示出等效性。需要对具有不同专业水平的多名内窥镜医师进行进一步的多中心试验，并需要显示癌症或癌症相关死亡减少的长期结果数据。