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ASGE Technology Committee systematic review and meta-analysis assessing the ASGE Preservation and Incorporation of Valuable Endoscopic Innovations thresholds for adopting real-time imaging-assisted endoscopic targeted biopsy during endoscopic surveillance of Barrett's esophagus.
Gastrointest Endosc 2016; 83(4):684-98.e7GE

Abstract

BACKGROUND AND AIMS

Endoscopic real-time imaging of Barrett's esophagus (BE) with advanced imaging technologies enables targeted biopsies and may eliminate the need for random biopsies to detect dysplasia during endoscopic surveillance of BE. This systematic review and meta-analysis was performed by the American Society for Gastrointestinal Endoscopy (ASGE) Technology Committee to specifically assess whether acceptable performance thresholds outlined by the ASGE Preservation and Incorporation of Valuable Endoscopic Innovations (PIVI) document for clinical adoption of these technologies have been met.

METHODS

We conducted meta-analyses calculating the pooled sensitivity, negative predictive value (NPV), and specificity for chromoendoscopy by using acetic acid and methylene blue, electronic chromoendoscopy by using narrow-band imaging, and confocal laser endomicroscopy (CLE) for the detection of dysplasia. Random effects meta-analysis models were used. Statistical heterogeneity was evaluated by means of I(2) statistics.

RESULTS

The pooled sensitivity, NPV, and specificity for acetic acid chromoendoscopy were 96.6% (95% confidence interval [CI], 95-98), 98.3% (95% CI, 94.8-99.4), and 84.6% (95% CI, 68.5-93.2), respectively. The pooled sensitivity, NPV, and specificity for electronic chromoendoscopy by using narrow-band imaging were 94.2% (95% CI, 82.6-98.2), 97.5% (95% CI, 95.1-98.7), and 94.4% (95% CI, 80.5-98.6), respectively. The pooled sensitivity, NPV, and specificity for endoscope-based CLE were 90.4% (95% CI, 71.9-97.2), 98.3% (95% CI, 94.2-99.5), and 92.7% (95% CI, 87-96), respectively.

CONCLUSIONS

Our meta-analysis indicates that targeted biopsies with acetic acid chromoendoscopy, electronic chromoendoscopy by using narrow-band imaging, and endoscope-based CLE meet the thresholds set by the ASGE PIVI, at least when performed by endoscopists with expertise in advanced imaging techniques. The ASGE Technology Committee therefore endorses using these advanced imaging modalities to guide targeted biopsies for the detection of dysplasia during surveillance of patients with previously nondysplastic BE, thereby replacing the currently used random biopsy protocols.

Authors

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Pub Type(s)

Journal Article
Meta-Analysis
Review
Systematic Review

Language

eng

PubMed ID

26874597

Citation

ASGE Technology Committee, et al. "ASGE Technology Committee Systematic Review and Meta-analysis Assessing the ASGE Preservation and Incorporation of Valuable Endoscopic Innovations Thresholds for Adopting Real-time Imaging-assisted Endoscopic Targeted Biopsy During Endoscopic Surveillance of Barrett's Esophagus." Gastrointestinal Endoscopy, vol. 83, no. 4, 2016, pp. 684-98.e7.
ASGE Technology Committee, Thosani N, Abu Dayyeh BK, et al. ASGE Technology Committee systematic review and meta-analysis assessing the ASGE Preservation and Incorporation of Valuable Endoscopic Innovations thresholds for adopting real-time imaging-assisted endoscopic targeted biopsy during endoscopic surveillance of Barrett's esophagus. Gastrointest Endosc. 2016;83(4):684-98.e7.
Thosani, N., Abu Dayyeh, B. K., Sharma, P., Aslanian, H. R., Enestvedt, B. K., Komanduri, S., ... Banerjee, S. (2016). ASGE Technology Committee systematic review and meta-analysis assessing the ASGE Preservation and Incorporation of Valuable Endoscopic Innovations thresholds for adopting real-time imaging-assisted endoscopic targeted biopsy during endoscopic surveillance of Barrett's esophagus. Gastrointestinal Endoscopy, 83(4), pp. 684-98.e7. doi:10.1016/j.gie.2016.01.007.
ASGE Technology Committee, et al. ASGE Technology Committee Systematic Review and Meta-analysis Assessing the ASGE Preservation and Incorporation of Valuable Endoscopic Innovations Thresholds for Adopting Real-time Imaging-assisted Endoscopic Targeted Biopsy During Endoscopic Surveillance of Barrett's Esophagus. Gastrointest Endosc. 2016;83(4):684-98.e7. PubMed PMID: 26874597.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - ASGE Technology Committee systematic review and meta-analysis assessing the ASGE Preservation and Incorporation of Valuable Endoscopic Innovations thresholds for adopting real-time imaging-assisted endoscopic targeted biopsy during endoscopic surveillance of Barrett's esophagus. AU - ,, AU - Thosani,Nirav, AU - Abu Dayyeh,Barham K, AU - Sharma,Prateek, AU - Aslanian,Harry R, AU - Enestvedt,Brintha K, AU - Komanduri,Sri, AU - Manfredi,Michael, AU - Navaneethan,Udayakumar, AU - Maple,John T, AU - Pannala,Rahul, AU - Parsi,Mansour A, AU - Smith,Zachary L, AU - Sullivan,Shelby A, AU - Banerjee,Subhas, Y1 - 2016/02/11/ PY - 2016/01/05/received PY - 2016/01/05/accepted PY - 2016/2/15/entrez PY - 2016/2/15/pubmed PY - 2016/12/23/medline SP - 684 EP - 98.e7 JF - Gastrointestinal endoscopy JO - Gastrointest. Endosc. VL - 83 IS - 4 N2 - BACKGROUND AND AIMS: Endoscopic real-time imaging of Barrett's esophagus (BE) with advanced imaging technologies enables targeted biopsies and may eliminate the need for random biopsies to detect dysplasia during endoscopic surveillance of BE. This systematic review and meta-analysis was performed by the American Society for Gastrointestinal Endoscopy (ASGE) Technology Committee to specifically assess whether acceptable performance thresholds outlined by the ASGE Preservation and Incorporation of Valuable Endoscopic Innovations (PIVI) document for clinical adoption of these technologies have been met. METHODS: We conducted meta-analyses calculating the pooled sensitivity, negative predictive value (NPV), and specificity for chromoendoscopy by using acetic acid and methylene blue, electronic chromoendoscopy by using narrow-band imaging, and confocal laser endomicroscopy (CLE) for the detection of dysplasia. Random effects meta-analysis models were used. Statistical heterogeneity was evaluated by means of I(2) statistics. RESULTS: The pooled sensitivity, NPV, and specificity for acetic acid chromoendoscopy were 96.6% (95% confidence interval [CI], 95-98), 98.3% (95% CI, 94.8-99.4), and 84.6% (95% CI, 68.5-93.2), respectively. The pooled sensitivity, NPV, and specificity for electronic chromoendoscopy by using narrow-band imaging were 94.2% (95% CI, 82.6-98.2), 97.5% (95% CI, 95.1-98.7), and 94.4% (95% CI, 80.5-98.6), respectively. The pooled sensitivity, NPV, and specificity for endoscope-based CLE were 90.4% (95% CI, 71.9-97.2), 98.3% (95% CI, 94.2-99.5), and 92.7% (95% CI, 87-96), respectively. CONCLUSIONS: Our meta-analysis indicates that targeted biopsies with acetic acid chromoendoscopy, electronic chromoendoscopy by using narrow-band imaging, and endoscope-based CLE meet the thresholds set by the ASGE PIVI, at least when performed by endoscopists with expertise in advanced imaging techniques. The ASGE Technology Committee therefore endorses using these advanced imaging modalities to guide targeted biopsies for the detection of dysplasia during surveillance of patients with previously nondysplastic BE, thereby replacing the currently used random biopsy protocols. SN - 1097-6779 UR - https://www.unboundmedicine.com/medline/citation/26874597/ASGE_Technology_Committee_systematic_review_and_meta_analysis_assessing_the_ASGE_Preservation_and_Incorporation_of_Valuable_Endoscopic_Innovations_thresholds_for_adopting_real_time_imaging_assisted_endoscopic_targeted_biopsy_during_endoscopic_surveillance_of_Barrett's_esophagus_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0016-5107(16)00030-4 DB - PRIME DP - Unbound Medicine ER -