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Narrow band imaging for detection of gastric intestinal metaplasia and dysplasia: A systematic review and meta‐analysis
Author(s) -
Desai Madhav,
Boregowda Umesha,
Srinivasan Sachin,
Kohli Divyanshoo R.,
Al Awadhi Sameer,
Murino Alberto,
Yu Lawrence Ho Khek,
DinisRibeiro Doutor Mário,
Sharma Prateek
Publication year - 2021
Publication title -
journal of gastroenterology and hepatology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.214
H-Index - 130
eISSN - 1440-1746
pISSN - 0815-9319
DOI - 10.1111/jgh.15564
Subject(s) - medicine , dysplasia , gastroenterology , intestinal metaplasia , narrow band imaging , prospective cohort study , barrett's esophagus , odds ratio , endoscopy , adenocarcinoma , cancer
Background and Aims Gastric intestinal metaplasia (GIM), a precursor of gastric adenocarcinoma, is challenging to diagnose with white light endoscopy (WLE) and can be missed by random gastric biopsies. Narrowband imaging (NBI) may potentially improve the detection of GIM. However, pooled estimates from prospective studies are lacking. Methods Electronic databases were searched for studies comparing NBI and WLE alone for detection of GIM and synchronous dysplasia. Primary outcome was pooled detection rate of GIM by NBI compared with WLE in prospective studies. The secondary outcome was concurrent dysplasia detection. Results Ten studies were found eligible from 306 articles screened. Eight prospective studies were found eligible for primary endpoint of GIM detection. Two other retrospective studies were included for dysplasia detection. A total of 1366 subjects (694 males, 54.4 ± 5.08 years) underwent upper endoscopy. GIM was detected in 482 (35.3%) subjects. NBI detected GIM in 32% additional subjects (70% vs 38%, RR 1.79; 95% CI 1.34–2.37; P < 0.01). Subgroup analysis revealed newer NBI scopes (GIF260) detected significantly more GIM than WLE (RR 2.47; 95% CI 1.63–3.76; P < 0.01) but not the older (H180) NBI endoscopes (RR 1.33; 95% CI 0.93–1.88; P = 0.11). There was moderate heterogeneity between the studies ( I 2 = 63%). In five studies ( n = 628) that reported dysplasia, there was no significant difference between NBI and WLE in dysplasia detection (RR 1.09; 95% CI 0.81–1.47; P = 0.58). Conclusion Narrowband imaging can significantly increase the detection of GIM when used in addition to standard white light exam during an upper endoscopy.