Standard Definition White Light Endoscopy Is an Inferior Surveillance Modality for Ulcerative Colitis

Surface of the colon in a patient with ulcerative colitis.
Surface of the colon in a patient with ulcerative colitis.
The majority of endoscopic modalities for ulcerative colitis (UC) neoplasia surveillance were similarly effective, but white light standard definition (WL SD) was the least so.

The majority of endoscopic modalities for the surveillance of ulcerative colitis (UC) neoplasia were similarly effective, but white light standard definition (WL SD) was inferior to others, according to results from a meta-analysis of randomized controlled trials (RCTs) published in the World Journal of Gastrointestinal Endoscopy.

Researchers searched numerous article databases through May 2016. They selected RCTs evaluating the efficacy of neoplasia surveillance in UC by endoscopic modalities. The 4 endoscopic modalities were: WL SD, WL high definition (WL HD), chromoendoscopy HD (CE HD), and narrow band imaging HD (NBI HD). The researchers selected studies including information about low- or high-grade dysplasia detection rates. The meta-analysis had a total of 6 prospective RCTs of 1038 total patients. These data were analyzed using a Bayesian framework. The modality rank was determined by surface under the cumulative ranking (SUCRA) method.

A network meta-analysis ranked the modalities in the following order for detecting dysplasia per biopsy: NBI HD (SUCRA, 0.78; 95% CI, 0.41-1.14), CE HD (SUCRA, 0.66; 95% CI, 0.29-1.03), WL SD (SUCRA, 0.33; 95% CI, -0.04-0.70), and WL HD (SUCRA, 0.24; 95% CI, -0.13-0.61). A direct meta-analysis of dysplasia per biopsy supported the ranking that indicated NBI HD out-performed WL HD with an odds ratio of 5.71 (95% CI, 1.87-17.47).

The network analysis for detecting dysplasia per patient reorganized the previous ranking as: WL HD (SUCRA, 0.81; 95% CI, 0.45-1.18), NBI HD (SUCRA, 0.71; 95% CI, 0.34-1.08), CE HD (SUCRA, 0.42; 95% CI, 0.06-0.79) and WL SD (SUCRA, 0.06; 95% CI, -0.31-0.43). That rank remained the same for numbers of dysplasia detected per patient: WL HD (SUCRA, 0.88; 95% CI, 0.51-1.24), NBI HD (SUCRA, 0.62; 95% CI, 0.25- 0.99), CE HD (SUCRA, 0.48; 95% CI, 0.11-0.84) and WL SD (SUCRA, 0.03; 95% CI, -0.33-0.40).

Limitations of the review included the small number of studies used in the analysis and the inconsistency in study design among RCTs. Only 1 study compared CE HD vs NBI HD or CE HD vs WL SD. No studies compared CE HD to WL HD or WL SD to WL HD. This lack of data made the direct meta-analysis impossible for most comparisons.

The study authors concluded that the 3 HD modalities (WL HD, NBI HD, and CE HD) were similarly effective in detecting dysplasia among patients with UC and that WL SD was an inferior modality for UC surveillance.


Gondal B, Haider H, Komaki Y, et al. Efficacy of various endoscopic modalities in detecting dysplasia in ulcerative colitis: a systematic review and network meta-analysis. World J Gastrointest Endosc. 2020 May 16;12(5):159-171. doi:10.4253/wjge.v12.i5.159