Abstract
BackgroundThe diagnostic yield of light blue crest(LBC) sign, which was observed by narrow band imaging with magnification endoscopy(NBI-ME), in detecting gastric intestinal metaplasia(IM) has shown variable results.ObjectiveWe aimed to assess the diagnostic value of LBC under NBI-ME for detecting gastric IM.MethodsWe performed a literature search of the Medline/PubMed, Embase, Web of Science, Science Direct and the Cochrane Library Databases; and a meta-analysis of pooled sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, and SROC area under the curve, using fixed- and random-effects models, for the accuracy of LBC-based IM diagnosis.ResultsWe initially included 4 articles, but excluded 1 article to counter significant heterogeneity. When pooled, the remaining 3 articles, which included 247 patients with 721 lesions, showed the following patterns in IM diagnosis: sensitivity: 0.90 (95% confidence interval [CI] 0.86–0.92); specificity: 0.90 (95% CI 0.86–0.93), positive likelihood ratio: 8.98 (95% CI 6.42–12.58), negative likelihood ratio: 0.12 (95% CI 0.09–0.16), and SROC area under the curve: 0.9560.LimitationsAs the studies varied by their definitions for positive LBC, endoscopy types, biopsy protocols, race of patient cohort, and physicians' proficiency, some sample sizes were limited so that subgroup analyses could not be performed.ConclusionWe concluded that observing LBC under NBI-ME is an accurate and precise means of diagnosing gastric IM.
Highlights
Gastric intestinal metaplasia (IM) is regarded as a precancerous lesion [1], accurate surveillance of which could lead to early detection and treatment before further progression, preventing gastric cancer and improving patient survival [2]
We concluded that observing light blue crest (LBC) under Narrow band imaging (NBI)-magnification endoscopy (ME) is an accurate and precise means of diagnosing gastric IM
Selection of studies Studies were selected according to the inclusion criteria: (1) aim of clarifying the accuracy of LBC in diagnosing gastric IM; (2) use of the Updated Sydney System Criteria or Chinese Consensus for the Diagnosis of Chronic Gastritis as pathological diagnostic criteria; (3) use of NBI-ME in all subjects, followed by the pathological examination; (4) use of ‘‘with or without LBC’’ as the standard to diagnose gastric IM under endoscopy; (5) recruitment of non-specific population for the study; (6) calculations for true or false-positive value, and true or false-negative value by directly or indirectly acquired LBC in gastric IM
Summary
Gastric intestinal metaplasia (IM) is regarded as a precancerous lesion [1], accurate surveillance of which could lead to early detection and treatment before further progression, preventing gastric cancer and improving patient survival [2]. As distribution of IM is patchy and is not distinctly visible by routine white-light endoscopy, use of the random biopsy technique is subject to sampling error [3,4]. The light blue crest (LBC), a blue-whitish patchy area observable with NBI-magnification endoscopy (ME) on the gastric epithelial surface, may have a distinctive endoscopic diagnostic appearance of IM [3]. This meta-analysis aimed to assess the diagnostic accuracy, sensitivity, and specificity of LBC under NBI-ME in diagnosing gastric IM. The diagnostic yield of light blue crest(LBC) sign, which was observed by narrow band imaging with magnification endoscopy(NBI-ME), in detecting gastric intestinal metaplasia(IM) has shown variable results
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