Background Current guidelines strongly recommend the use of validated classifications to support optical diagnosis of lesions with advanced endoscopic imaging in the lower gastrointestinal tract. However, the optimal strategy in inflammatory bowel disease (IBD) is still a matter of debate. Objectives To analyze the accuracy of endoscopic classifications or single predictors for in vivo lesion characterization during endoscopic surveillance of IBD with advanced endoscopic imaging. Design Systematic review. Data sources and methods Medline and PubMed were used to extract all studies which focused on lesion characterization of neoplastic and non-neoplastic lesions in IBD. The diagnostic accuracy of endoscopic classifications and single endoscopic predictors for lesion characterization were analyzed according to type of patients, lesions, and technology used. When available, the rates of true and false positives or negatives for neoplasia were pooled and the sensitivity (SE), specificity (SP), positive predictive value, and negative predictive value (NPV) were calculated. Results We included 35 studies (2789 patients; 5925 lesions - 1149 neoplastic). Advanced endoscopic imaging included dye-based chromoendoscopy, virtual chromoendoscopy (VCE), magnification and high-definition endoscopy, confocal laser endomicroscopy (CLE), endocytoscopy, and autofluorescence imaging. The Kudo classification of pit patterns was most frequently used, with pooled SE 83%, SP 83%, and NPV 95%. The endoscopic criteria with the highest accuracy, with minimum SE ⩾ 90%, SP ⩾ 80%, and NPV ⩾ 90% were: the Kudo-IBD classification used with VCE (Fuji Intelligent Color Enhancement and i-SCAN); combined irregular surface and vascular patterns used with narrow band imaging; the Mainz classification used with CLE. Multiple clinical and technical factors were found to influence the accuracy of optical diagnosis in IBD. Conclusion No single endoscopic factor has yet shown sufficient accuracy for lesion characterization in IBD surveillance. Conventional classifications developed in the non-IBD setting have lower accuracy in IBD. The use of new classifications adapted for IBD (Kudo-IBD), and new technologies based on in vivo microscopic analysis show promise.

中文翻译：

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炎症性肠病肿瘤性和非肿瘤性病变的内镜特征：先进内镜成像时代的系统评价。

背景 目前的指南强烈建议使用经过验证的分类来支持下消化道先进内窥镜成像对病变的光学诊断。然而，炎症性肠病（IBD）的最佳策略仍然存在争议。目的 分析使用先进内镜成像进行内镜监测 IBD 期间内镜分类或体内病变表征的单一预测因子​​的准确性。设计系统审查。数据来源和方法 Medline 和 PubMed 用于提取所有关注 IBD 肿瘤性和非肿瘤性病变特征的研究。根据患者类型、病变和所使用的技术，分析内窥镜分类和单一内窥镜预测病变特征的诊断准确性。如果有的话，汇总肿瘤的真阳性率和假阳性率或阴性率，并计算敏感性（SE）、特异性（SP）、阳性预测值和阴性预测值（NPV）。结果 我们纳入了 35 项研究（2789 名患者；5925 个病变 - 1149 个肿瘤）。先进的内窥镜成像包括染料色素内窥镜、虚拟色素内窥镜 (VCE)、放大和高清内窥镜、共焦激光内窥镜 (CLE)、内吞细胞镜和自发荧光成像。凹坑模式的 Kudo 分类最常用，合并 SE 83%、SP 83% 和 NPV 95%。准确度最高的内窥镜标准（最低 SE ⩾ 90%、SP ⩾ 80% 和 NPV ⩾ 90%）是： 与 VCE（Fuji 智能色彩增强和 i-SCAN）结合使用的 Kudo-IBD 分类；将不规则表面和血管图案与窄带成像相结合；与 CLE 一起使用的美因茨分类。研究发现多种临床和技术因素会影响 IBD 光学诊断的准确性。结论 在 IBD 监测中，尚无单一内镜因素对病变特征表现出足够的准确性。在非 IBD 环境中开发的传统分类在 IBD 中的准确性较低。适用于 IBD 的新分类 (Kudo-IBD) 和基于体内显微分析的新技术的使用显示出了希望。