Rokkas Theodore, Ekmektzoglou Konstantinos
Department of Gastroenterology, Henry Dunant Hospital Center, Athens, Greece (Theodore Rokkas, Konstantinos Ekmektzoglou).
Medical School, European University of Cyprus, Nicosia, Cyprus (Theodore Rokkas, Konstantinos Ekmektzoglou).
Ann Gastroenterol. 2023 Mar-Apr;36(2):149-156. doi: 10.20524/aog.2023.0784. Epub 2023 Feb 7.
Gastric intestinal metaplasia (GIM) can be missed by random gastric biopsies taken during white light endoscopy. Narrow band imaging (NBI) may potentially improve the detection of GIM. However, pooled estimates from prospective studies are lacking and the diagnostic accuracy of NBI in detecting GIM needs to be more precisely defined. The aim of this systematic review and meta-analysis was to study the diagnostic performance of NBI in detecting GIM.
PubMed/Medline and EMBASE were screened for studies examining GIM in relation to NBI. Data from each study were extracted and calculations of pooled sensitivity, specificity, likelihood ratios, diagnostic odds ratios (DORs), and areas under the curve (AUCs) were performed. Fixed or random effects models, were used as appropriate, depending on the presence of significant heterogeneity.
We included 11 eligible studies in the meta-analysis, comprising 1672 patients. NBI showed a pooled sensitivity of 80% (95% confidence interval [CI] 69-87), specificity of 93% (95%CI 85-97), DOR 48 (95%CI 20-121), and AUC of 0.93 (95%CI 0.91-0.95) in detecting GIM.
This meta-analysis showed that NBI is a reliable endoscopic means of detecting GIM. NBI with magnification performed better than NBI without magnification. However, better designed prospective studies are needed to precisely determine the diagnostic role of NBI, especially in high-risk populations where early detection of GIM can impact gastric cancer prevention and survival.
白光内镜检查时随机采集的胃活检可能会漏诊胃肠化生（GIM）。窄带成像（NBI）可能会提高GIM的检出率。然而，前瞻性研究的汇总估计数据尚缺，NBI检测GIM的诊断准确性需要更精确地界定。本系统评价和荟萃分析的目的是研究NBI检测GIM的诊断性能。
检索PubMed/Medline和EMBASE数据库，查找有关NBI与GIM关系的研究。提取每项研究的数据，并计算汇总敏感性、特异性、似然比、诊断比值比（DOR）和曲线下面积（AUC）。根据是否存在显著异质性，酌情使用固定效应模型或随机效应模型。
我们在荟萃分析中纳入了11项符合条件的研究，共1672例患者。NBI检测GIM的汇总敏感性为80%（95%置信区间[CI]69-87），特异性为93%（95%CI 85-97），DOR为48（95%CI 20-121），AUC为0.93（95%CI 0.91-0.95）。
这项荟萃分析表明，NBI是检测GIM的一种可靠的内镜检查方法。放大内镜下的NBI比未放大内镜下的NBI表现更好。然而，需要设计更完善的前瞻性研究来精确确定NBI的诊断作用，尤其是在GIM早期检测可影响胃癌预防和生存的高危人群中。
