Abstract
Background Image-enhanced endoscopy (IEE) improves the accuracy of endoscopic diagnosis. We aimed
to assess the value of IEE for gastric preneoplastic conditions and neoplastic lesions.
Methods Medline and Embase were searched until December 2018. Studies allowing calculation
of diagnostic measures were included. Risk of bias and applicability were assessed
using QUADAS-2. Subgroup analysis was performed to explore heterogeneity.
Results 44 studies met the inclusion criteria. For gastric intestinal metaplasia (GIM), narrow-band
imaging (NBI) obtained a pooled sensitivity and specificity of 0.79 (95 %CI 0.72–0.85)
and 0.91 (95 %CI 0.88–0.94) on per-patient basis; on per-biopsy basis, it was 0.84
(95 %CI 0.81–0.86) and 0.95 (95 %CI 0.94–0.96), respectively. Tubulovillous pattern
was the most accurate marker to detect GIM and it was effectively assessed without
high magnification. For dysplasia, NBI showed a pooled sensitivity and specificity
of 0.87 (95 %CI 0.84–0.89) and 0.97 (95 %CI 0.97–0.98) on per-biopsy basis. The use
of magnification improved the performance of NBI to characterize early gastric cancer
(EGC), especially when the vessel plus surface (VS) classification was applied. Regarding
other technologies, trimodal imaging also obtained a high accuracy for dysplasia (sensitivity
0.93 [95 %CI 0.85–0.98], specificity 0.98 [95 %CI 0.92–1.00]). For atrophic gastritis,
no specific pattern was noted and none of the technologies reached good diagnostic
yield.
Conclusion NBI is highly accurate for GIM and dysplasia. The presence of tubulovillous pattern
and the VS classification seem to be useful to detect GIM and characterize EGC, respectively.
These features should be used in current practice and to standardize endoscopic criteria
for other technologies.
