The Diagnostic Performance of Linked Color Imaging Compared to White Light Imaging in Endoscopic Diagnosis of Helicobacter pylori Infection: A Systematic Review and Meta-Analysis

Abstract

Background/aims: Recognizing Helicobacter pylori infection during endoscopy is important because it can lead to the performance of confirmatory testing. Linked color imaging (LCI) is an image enhancement technique that can improve the detection of gastrointestinal lesions. The purpose of this study was to compare LCI to conventional white light imaging (WLI) in the endoscopic diagnosis of H. pylori infection.

Methods: We conducted a comprehensive literature search using PubMed, Embase, and the Cochrane Library. All studies evaluating the diagnostic performance of LCI or WLI in the endoscopic diagnosis of H. pylori were eligible. Studies on magnifying endoscopy, chromoendoscopy, and artificial intelligence were excluded.

Results: Thirty-four studies were included in this meta-analysis, of which 32 reported the performance of WLI and eight reported the performance of LCI in diagnosing H. pylori infection. The pooled sensitivity and specificity of WLI in the diagnosis of H. pylori infection were 0.528 (95% confidence interval [CI], 0.517 to 0.540) and 0.821 (95% CI, 0.811 to 0.830), respectively. The pooled sensitivity and specificity of LCI in the diagnosis of H. pylori were 0.816 (95% CI, 0.790 to 0.841) and 0.868 (95% CI, 0.850 to 0.884), respectively. The pooled diagnostic odds ratios of WLI and LCI were 15.447 (95% CI, 8.225 to 29.013) and 31.838 (95% CI, 15.576 to 65.078), respectively. The areas under the summary receiver operating characteristic curves of WLI and LCI were 0.870 and 0.911, respectively.

Conclusions: LCI showed higher sensitivity in the endoscopic diagnosis of H. pylori infection than standard WLI.

Keywords: Gastrointestinal endoscopy; Helicobacter pylori; Image enhancement; Sensitivity and specificity.

Fig. 1

Preferred Reporting Items for Systematic Reviews and Meta-Analyses flowchart.

Fig. 2

Pooled estimates of sensitivity and specificity of WLI in endoscopic diagnosis of Helicobacter pylori infection. WLI, white light imaging; CI, confidence interval.

Fig. 2

Pooled estimates of sensitivity and specificity of WLI in endoscopic diagnosis of Helicobacter pylori infection. WLI, white light imaging; CI, confidence interval.

Fig. 3

Pooled estimates of the sensitivity and specificity of LCI in endoscopic diagnosis of Helicobacter pylori infection. LCI, linked color imaging; CI, confidence interval.

Fig. 4

SROC curves of (A) white light imaging and (B) linked color imaging in diagnosing Helicobacter pylori infection. SROC, summary receiver operating characteristic; AUC, area under the curve; SE, standard error.

Fig. 5

Pooled estimates of the sensitivity and specificity of WLI and LCI from paired data of six studies in which both imaging modalities were performed on the same patients. (A) Pooled sensitivity of WLI. (B) Pooled specificity of WLI. (C) Pooled sensitivity of LCI. (D) Pooled specificity of LCI. WLI, white light imaging; LCI, linked color imaging; CI, confidence interval.