One in three adenomas could be missed by white-light colonoscopy - findings from a systematic review and meta-analysis.
Level 1 - systematic review of randomized trials
Systematic review and meta-analysis of diagnostic tandem studies
PubMed 40082770 · doi:10.1186/s12876-025-03679-4
What was done
Authors conducted a systematic review across MEDLINE, EMBASE, Cochrane Library, and grey literature for tandem colonoscopy studies comparing conventional white-light colonoscopy (WLC) to novel colonoscopic technologies in screening, diagnostic, or surveillance cohorts. Study quality was evaluated using the QUADAS-2 tool. Random-effects meta-analyses and meta-regression were performed to calculate pooled adenoma miss rates (AMR) with 95% confidence intervals overall and across subgroups of adenoma size, histology, morphology, and location.
What was found
From 5,963 identified studies, 16 studies including 4,101 individuals were analyzed. The pooled overall AMR for WLC was 34% (95% CI: 30–38%). Subgroup analyses showed significant AMR variations by size (1–5 mm: 36%; 6–9 mm: 27%; ≥10 mm: 12%), histology (non-advanced: 42%; advanced: 21%), and morphology (flat: 50%; polypoid: 27%). Miss rates did not differ significantly by location (distal: 36%; proximal: 36%).
Why it matters
Missing one in three adenomas during standard white-light colonoscopy substantially contributes to interval colorectal cancers. It also indicates that using WLC as a reference standard in screening validation studies likely distorts sensitivity estimates for non-invasive modalities like fecal occult blood tests.
Limits
Tandem comparison relies on novel colonoscopy technologies, which themselves do not detect 100% of adenomas, potentially underestimating true miss rates. The abstract does not report data on bowel preparation quality, withdrawal times, endoscopist experience, or the heterogeneity between specific novel imaging modalities.
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