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Advanced imaging technologies increase detection of dysplasia and neoplasia in patients with Barrett's esophagus: a meta-analysis and systematic review.
Clin Gastroenterol Hepatol 2013; 11(12):1562-70.e1-2CG

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.

Authors+Show Affiliations

Division of Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, Florida.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Evaluation Studies
Journal Article
Meta-Analysis
Research Support, N.I.H., Extramural
Research Support, U.S. Gov't, Non-P.H.S.
Review
Systematic Review

Language

eng

PubMed ID

23851020

Citation

Qumseya, Bashar J., et al. "Advanced Imaging Technologies Increase Detection of Dysplasia and Neoplasia in Patients With Barrett's Esophagus: a Meta-analysis and Systematic Review." Clinical Gastroenterology and Hepatology : the Official Clinical Practice Journal of the American Gastroenterological Association, vol. 11, no. 12, 2013, pp. 1562-70.e1-2.
Qumseya BJ, Wang H, Badie N, et al. Advanced imaging technologies increase detection of dysplasia and neoplasia in patients with Barrett's esophagus: a meta-analysis and systematic review. Clin Gastroenterol Hepatol. 2013;11(12):1562-70.e1-2.
Qumseya, B. J., Wang, H., Badie, N., Uzomba, R. N., Parasa, S., White, D. L., ... Wallace, M. B. (2013). Advanced imaging technologies increase detection of dysplasia and neoplasia in patients with Barrett's esophagus: a meta-analysis and systematic review. Clinical Gastroenterology and Hepatology : the Official Clinical Practice Journal of the American Gastroenterological Association, 11(12), pp. 1562-70.e1-2. doi:10.1016/j.cgh.2013.06.017.
Qumseya BJ, et al. Advanced Imaging Technologies Increase Detection of Dysplasia and Neoplasia in Patients With Barrett's Esophagus: a Meta-analysis and Systematic Review. Clin Gastroenterol Hepatol. 2013;11(12):1562-70.e1-2. PubMed PMID: 23851020.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Advanced imaging technologies increase detection of dysplasia and neoplasia in patients with Barrett's esophagus: a meta-analysis and systematic review. AU - Qumseya,Bashar J, AU - Wang,Haibo, AU - Badie,Nicole, AU - Uzomba,Rosemary N, AU - Parasa,Sravanthi, AU - White,Donna L, AU - Wolfsen,Herbert, AU - Sharma,Prateek, AU - Wallace,Michael B, Y1 - 2013/07/12/ PY - 2013/03/15/received PY - 2013/06/14/revised PY - 2013/06/17/accepted PY - 2013/7/16/entrez PY - 2013/7/16/pubmed PY - 2014/7/8/medline KW - AI KW - Advanced Imaging KW - BE KW - Barrett’s Esophagus KW - Barrett’s esophagus KW - CBE KW - CE KW - CI KW - CLE KW - EAC KW - Esophageal Adenocarcinoma KW - FICE KW - Fujinon intelligent chromoendoscopy KW - NBI KW - PRISMA KW - QUADAS KW - Quality Assessment of Diagnostic Accuracy Studies KW - RB KW - RD KW - Risk Difference KW - VC KW - WLE KW - advanced imaging KW - chromoendoscopy KW - complete Barrett excision KW - confidence interval KW - confocal laser endomicroscopy KW - esophageal adenocarcinoma KW - narrow-band imaging KW - random biopsy KW - risk difference KW - virtual chromoendoscopy KW - white-light endoscopy SP - 1562-70.e1-2 JF - Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association JO - Clin. Gastroenterol. Hepatol. VL - 11 IS - 12 N2 - 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. SN - 1542-7714 UR - https://www.unboundmedicine.com/medline/citation/23851020/Advanced_imaging_technologies_increase_detection_of_dysplasia_and_neoplasia_in_patients_with_Barrett's_esophagus:_a_meta_analysis_and_systematic_review_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S1542-3565(13)00922-1 DB - PRIME DP - Unbound Medicine ER -