Glover Ben, Teare Julian, Ashrafian Hutan, Patel Nisha
Imperial College London, London, UK.
Imperial College London, London W2 1NY, UK.
Ther Adv Gastrointest Endosc. 2020 Oct 23;13:2631774520950840. doi: 10.1177/2631774520950840. eCollection 2020 Jan-Dec.
The endoscopic findings associated with -naïve status, current infection or past infection are an area of ongoing interest. Previous studies have investigated parameters with a potential diagnostic value. The aim of this study was to perform meta-analysis of the available literature to validate the diagnostic accuracy of mucosal features proposed in the Kyoto classification.
The databases of MEDLINE and Embase, clinicalTrials.gov and the Cochrane Library were systematically searched for relevant studies from October 1999 to October 2019.
A bivariate random effects model was used to produce pooled diagnostic accuracy calculations for each of the studied endoscopic findings. Diagnostic odds ratios and sensitivity and specificity characteristics were calculated to identify significant predictors of status.
Meta-analysis included 4380 patients in 15 studies. The most significant predictor of an -naïve status was a regular arrangement of collecting venules (diagnostic odds ratio 55.0, sensitivity 78.3%, specificity 93.8%). Predictors of active infection were mucosal oedema (18.1, 63.7%, 91.1%) and diffuse redness (14.4, 66.5%, 89.0%). Map-like redness had high specificity for previous eradication (99.0%), but poor specificity (13.0%).
The regular arrangement of collecting venules, mucosal oedema, diffuse redness and map-like redness are important endoscopic findings for determining status. This meta-analysis provides a tentative basis for developing future endoscopic classification systems.
与初治状态、现感染或既往感染相关的内镜检查结果是一个持续受到关注的领域。以往的研究已经对具有潜在诊断价值的参数进行了调查。本研究的目的是对现有文献进行荟萃分析，以验证京都分类法中提出的黏膜特征的诊断准确性。
对MEDLINE和Embase数据库、ClinicalTrials.gov以及Cochrane图书馆进行系统检索，以查找1999年10月至2019年10月期间的相关研究。
采用双变量随机效应模型对每项研究的内镜检查结果进行合并诊断准确性计算。计算诊断比值比以及敏感性和特异性特征，以确定状态的显著预测因素。
荟萃分析纳入了15项研究中的4380例患者。初治状态的最显著预测因素是集合小静脉的规则排列（诊断比值比55.0，敏感性78.3%，特异性93.8%）。现感染的预测因素是黏膜水肿（18.1，63.7%，91.1%）和弥漫性发红（14.4，66.5%，89.0%）。地图样发红对既往根除具有高特异性（99.0%），但特异性较差（13.0%）。
集合小静脉的规则排列、黏膜水肿、弥漫性发红和地图样发红是确定状态的重要内镜检查结果。这项荟萃分析为未来内镜分类系统的开发提供了初步依据。
