title: 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.
abstract: OBJECTIVE
  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.forename: Nirav
authors.initials: N
authors.lastname: Thosani
authors.forename: Barham K
authors.initials: BK
authors.lastname: Abu Dayyeh
authors.forename: Prateek
authors.initials: P
authors.lastname: Sharma
authors.forename: Harry R
authors.initials: HR
authors.lastname: Aslanian
authors.forename: Brintha K
authors.initials: BK
authors.lastname: Enestvedt
authors.forename: Sri
authors.initials: S
authors.lastname: Komanduri
authors.forename: Michael
authors.initials: M
authors.lastname: Manfredi
authors.forename: Udayakumar
authors.initials: U
authors.lastname: Navaneethan
authors.forename: John T
authors.initials: JT
authors.lastname: Maple
authors.forename: Rahul
authors.initials: R
authors.lastname: Pannala
authors.forename: Mansour A
authors.initials: MA
authors.lastname: Parsi
authors.forename: Zachary L
authors.initials: ZL
authors.lastname: Smith
authors.forename: Shelby A
authors.initials: SA
authors.lastname: Sullivan
authors.forename: Subhas
authors.initials: S
authors.lastname: Banerjee
mesh_terms: D019342:Acetic Acid; D001471:Barrett Esophagus / Q000000981:diagnostic imaging* / Q000473:pathology*; D001706:Biopsy / Q000379:methods; D004396:Coloring Agents; D004945:Esophagoscopy / Q000379:methods* / Q000592:standards; D004947:Esophagus / Q000473:pathology*; D006801:Humans; D000069416:Intravital Microscopy / Q000592:standards; D008751:Methylene Blue; D018613:Microscopy, Confocal / Q000592:standards; D062048:Narrow Band Imaging / Q000592:standards; D011237:Predictive Value of Tests; D057832:Watchful Waiting
chemical_list: D004396:Coloring Agents; D019342:Acetic Acid; D008751:Methylene Blue