title: Advanced imaging technologies increase detection of dysplasia and neoplasia in patients with Barrett's esophagus: a meta-analysis and systematic review.
abstract: OBJECTIVE
  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.affiliation: Division of Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, Florida.
authors.forename: Bashar J
authors.initials: BJ
authors.lastname: Qumseya
authors.forename: Haibo
authors.initials: H
authors.lastname: Wang
authors.forename: Nicole
authors.initials: N
authors.lastname: Badie
authors.forename: Rosemary N
authors.initials: RN
authors.lastname: Uzomba
authors.forename: Sravanthi
authors.initials: S
authors.lastname: Parasa
authors.forename: Donna L
authors.initials: DL
authors.lastname: White
authors.forename: Herbert
authors.initials: H
authors.lastname: Wolfsen
authors.forename: Prateek
authors.initials: P
authors.lastname: Sharma
authors.forename: Michael B
authors.initials: MB
authors.lastname: Wallace
mesh_terms: D001471:Barrett Esophagus / Q000150:complications* / Q000473:pathology*; D004724:Endoscopy / Q000379:methods*; D004938:Esophageal Neoplasms / Q000175:diagnosis* / Q000473:pathology*; D006801:Humans; D009369:Neoplasms; D061848:Optical Imaging / Q000379:methods*; D012680:Sensitivity and Specificity; D014481:United States
keywords: AI; Advanced Imaging; BE; Barrett’s Esophagus; Barrett’s esophagus; CBE; CE; CI; CLE; EAC; Esophageal Adenocarcinoma; FICE; Fujinon intelligent chromoendoscopy; NBI; PRISMA; QUADAS; Quality Assessment of Diagnostic Accuracy Studies; RB; RD; Risk Difference; VC; WLE; advanced imaging; chromoendoscopy; complete Barrett excision; confidence interval; confocal laser endomicroscopy; esophageal adenocarcinoma; narrow-band imaging; random biopsy; risk difference; virtual chromoendoscopy; white-light endoscopy