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. 2023 Dec 16;15(12):735-744.
doi: 10.4253/wjge.v15.i12.735.

Clinical usefulness of linked color imaging in identifying Helicobacter pylori infection: A systematic review and meta-analysis

Yu Zhang  1   2 , Jing-Zhai Wang  3   2 , Xuan Bai  3   2 , Peng-Li Zhang  3   2 , Qiang Guo  3   4
Affiliations

Clinical usefulness of linked color imaging in identifying Helicobacter pylori infection: A systematic review and meta-analysis

Yu Zhang et al. World J Gastrointest Endosc. .

Abstract

Background: Accurate diagnosis of Helicobacter pylori (H. pylori) infection status is a crucial premise for eradication therapy, as well as evaluation of risk for gastric cancer. Recent progress on imaging enhancement endoscopy (IEE) made it possible to not only detect precancerous lesions and early gastrointestinal cancers but also to predict H. pylori infection in real time. As a novel IEE modality, linked color imaging (LCI) has exhibited its value on diagnosis of lesions of gastric mucosa through emphasizing minor differences of color tone.

Aim: To compare the efficacy of LCI for H. pylori active infection vs conventional white light imaging (WLI).

Methods: PubMed, Embase, Embase and Cochrane Library were searched up to the end of April 11, 2022. The random-effects model was adopted to calculate the diagnostic efficacy of LCI and WLI. The calculation of sensitivity, specificity, and likelihood ratios were performed; symmetric receiver operator characteristic (SROC) curves and the areas under the SROC curves were computed. Quality of the included studies was chosen to assess using the quality assessment of diagnostic accuracy studies-2 tool.

Results: Seven original studies were included in this study. The pooled sensitivity, specificity, positive likelihood rate, and negative likelihood rate of LCI for the diagnosis of H. pylori infection of gastric mucosa were 0.85 [95% confidence interval (CI): 0.76-0.92], 0.82 (95%CI: 0.78-0.85), 4.71 (95%CI: 3.7-5.9), and 0.18 (95%CI: 0.10-0.31) respectively, with diagnostic odds ratio = 26 (95%CI: 13-52), SROC = 0.87 (95%CI: 0.84-0.90), which showed superiority of diagnostic efficacy compared to WLI.

Conclusion: Our results showed LCI can improve efficacy of diagnosis on H. pylori infection, which represents a useful endoscopic evaluation modality for clinical practice.

Keywords: Endoscopic diagnosis; Gastric cancer; Helicobacter pylori infection; Linked color imaging; Meta-analysis.

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Conflict of interest statement

Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.

Figures

Figure 1
Figure 1
Flow diagram of specific literature searching process.
Figure 2
Figure 2
The assessment of bias risk.
Figure 3
Figure 3
Pooled results of efficacy of white light imaging on Helicobacter pylori infection diagnosis. A-D: Pooled sensitivity (A), specificity (B), positive likelihood ratio and negative likelihood ratio (C). Symmetric receiver operator characteristic curve and area under the curve (D). 95%CI: 95% confidence interval; SROC: Symmetric receiver operator characteristic; PLR: Positive likelihood rate; NLR: Negative likelihood rate.
Figure 4
Figure 4
Pooled results of efficacy of linked color imaging on Helicobacter pylori infection diagnosis. A-D: Pooled sensitivity (A), specificity (B), positive likelihood ratio and negative likelihood ratio (C). Symmetric receiver operator characteristic curve and area under the curve (D). 95%CI: 95% confidence interval; SROC: Symmetric receiver operator characteristic; PLR: Positive likelihood rate; NLR: Negative likelihood rate.
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