Narrow band imaging for detection of gastric intestinal metaplasia and dysplasia: A systematic review and meta‐analysis

Abstract

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.

Gastric Cancer Screening; Current Modalities and Strategies

“…Chromoendoscopy (CE) using indigo carmine and acetic acid has been shown to be superior to WLE in detection of EGC with a sensitivity of 87.0% vs 56.5%, respectively, as well better ability in horizontal border delineation of differentiated-type EGC (93% vs 47.9%) [19][20]. Narrow band imaging (NBI) has been reported to be superior to WLE in identifying GIM with a recent metaanalysis showing a significantly higher detection rate of GIM (78% vs 38%), however, there was no statistically significant difference between the modalities in detecting dysplasia [21].…”

Kyoto classification of gastritis: Advances and future perspectives in endoscopic diagnosis of gastritis

“…Recently, image-enhanced endoscopy (IEE) has been widely used in clinical practice. Two meta-analyses previously reported the utility of narrow-band imaging (NBI) for the diagnosis of IM[ 72 , 73 ]. Additionally, an improved diagnostic accuracy on using NBI, blue laser imaging, and linked color imaging have been reported[ 74 - 77 ].…”

Endoscopic methods for the detection and treatment of gastric cancer

“…A severely irregular mucosal pattern with architectural distortion is concerning for dysplasia. High magnification NBI, blue laser imaging and confocal laser endocytoscopy have further increased the sensitivity and specificity of endoscopic surveillance [12,13]. These modalities allow for more targeted biopsies to be taken at time of endoscopy potentially increasing diagnostic yield.…”