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Meta-Analysis
. 2013 Dec;11(12):1562-70.e1-2.
doi: 10.1016/j.cgh.2013.06.017. Epub 2013 Jul 12.

Advanced imaging technologies increase detection of dysplasia and neoplasia in patients with Barrett's esophagus: a meta-analysis and systematic review

Bashar J Qumseya  1 , Haibo Wang, Nicole Badie, Rosemary N Uzomba, Sravanthi Parasa, Donna L White, Herbert Wolfsen, Prateek Sharma, Michael B Wallace
Affiliations
Meta-Analysis

Advanced imaging technologies increase detection of dysplasia and neoplasia in patients with Barrett's esophagus: a meta-analysis and systematic review

Bashar J Qumseya et al. Clin Gastroenterol Hepatol. 2013 Dec.

Abstract

Background & aims: US guidelines recommend surveillance of patients with Barrett's esophagus (BE) to detect dysplasia. BE conventionally is monitored via white-light endoscopy (WLE) and a collection of random biopsy specimens. However, this approach does not definitively or consistently detect areas of dysplasia. Advanced imaging technologies can increase the detection of dysplasia and cancer. We investigated whether these imaging technologies can increase the diagnostic yield for the detection of neoplasia in patients with BE, compared with WLE and analysis of random biopsy specimens.

Methods: We performed a systematic review, using Medline and Embase, to identify relevant peer-review studies. Fourteen studies were included in the final analysis, with a total of 843 patients. Our metameter (estimate) of interest was the paired-risk difference (RD), defined as the difference in yield of the detection of dysplasia or cancer using advanced imaging vs WLE. The estimated paired-RD and 95% confidence interval (CI) were obtained using random-effects models. Heterogeneity was assessed by means of the Q statistic and the I(2) statistic. An exploratory meta-regression was performed to look for associations between the metameter and potential confounders or modifiers.

Results: Overall, advanced imaging techniques increased the diagnostic yield for detection of dysplasia or cancer by 34% (95% CI, 20%-56%; P < .0001). A subgroup analysis showed that virtual chromoendoscopy significantly increased the diagnostic yield (RD, 0.34; 95% CI, 0.14-0.56; P < .0001). The RD for chromoendoscopy was 0.35 (95% CI, 0.13-0.56; P = .0001). There was no significant difference between virtual chromoendoscopy and chromoendoscopy, based on Student t test analysis (P = .45).

Conclusions: Based on a meta-analysis, advanced imaging techniques such as chromoendoscopy or virtual chromoendoscopy significantly increase the diagnostic yield for identification of dysplasia or cancer in patients with BE.

Keywords: AI; Advanced Imaging; BE; Barrett’s Esophagus; Barrett’s esophagus; CBE; CE; CI; CLE; EAC; Esophageal Adenocarcinoma; FICE; Fujinon intelligent chromoendoscopy; NBI; PRISMA; QUADAS; Quality Assessment of Diagnostic Accuracy Studies; RB; RD; Risk Difference; VC; WLE; advanced imaging; chromoendoscopy; complete Barrett excision; confidence interval; confocal laser endomicroscopy; esophageal adenocarcinoma; narrow-band imaging; random biopsy; risk difference; virtual chromoendoscopy; white-light endoscopy.

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Conflict of interest statement

Conflicts of Interest: Drs. Wallace and Wolfsen receive research funding from Olympus and Ninepoint Medical. Dr. Wallace is also a consultant for Cosmo pharmaceuticals. Dr. Wolfsen receives research funding from Olympus and NinePoint Medical. Dr. Wolfsen also is a consultant for CSA Medical, Mauna Kea Tech, Covidien (formerly BARRx).

Figures

Figure 1
Figure 1
Flow diagram demonstrating assessment and selection of studies in the meta-analysis.
Figure 2
Figure 2
Forest plot of the 14 studies with pooled risk difference for detection of dysplasia by advanced imaging compared to white light with random biopsies.
Figure 3
Figure 3
Forest plot of the 14 studies stratified by imaging modality (Virtual Chromoendoscopy in the top 7 studies, compared to chromoendoscopy in the bottom 7 studies) with pooled risk difference. Overall pooled risk difference is also shown.
Figure 4
Figure 4
Funnel plot to assess publication bias.
Figure 5
Figure 5
Forest plot of the 14 studies showing the pooled risk difference with one study removed at a time
See this image and copyright information in PMC

Comment in

References

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