Abstract
Objective: To conduct a systematic review and meta-analysis on the prediction of severity of gastric intestinal metaplasia (GIM) in localized and entire gastric mucosa using endoscopy. Methods: The authors searched Web of Science, PubMed, Embase and Cochrane Central Register of Controlled Trials and performed systematic searches on endoscopic grading of GIM of the entire stomach using Meta-DiSc and Stata. Results: Sensitivity and specificity for the stratified prediction of overall GIM were 0.91 (95% CI: 0.85–0.95) and 0.91 (95% CI: 0.88–0.93), respectively. Sensitivity in predicting the different grades of GIM was higher in operative link on GIM assessment grades 0, III and IV but lower in grades I and II. Conclusion: Digital chromoendoscopy is well suited to predicting the severity of localized and overall GIM.
Papers of special note have been highlighted as: •• of considerable interest
References
- 1. Occurrence of gastric cancer and carcinoids in atrophic gastritis during prospective long-term follow up. Scand. J. Gastroenterol. 50(7), 856–865 (2015).
- 2. . Helicobacter pylori status and risks of metachronous recurrence after endoscopic resection of early gastric cancer: a systematic review and meta-analysis. J. Gastroenterol. 54(3), 226–237 (2019).
- 3. Clinicopathologic characteristics of patients with gastric superficial neoplasia and risk factors for multiple lesions after endoscopic submucosal dissection in a western country. GE Port. J. Gastroenterol. 27(2), 76–89 (2020).
- 4. Randomized double-blind clinical trial of Moluodan for the treatment of chronic atrophic gastritis with dysplasia. Chin. J. Integr. Med. 22(1), 9–18 (2016).
- 5. . Hybrid argon plasma coagulation for treatment of gastric intestinal metaplasia. Cureus 12, e7427 (2020).
- 6. British Society of Gastroenterology guidelines on the diagnosis and management of patients at risk of gastric adenocarcinoma. Gut 68(9), 1545–1575 (2019).
- 7. Management of epithelial precancerous conditions and lesions in the stomach (MAPS II): European Society of Gastrointestinal Endoscopy (ESGE), European Helicobacter and Microbiota Study Group (EHMSG), European Society of Pathology (ESP), and Sociedade Port. Endoscopy 51(4), 365–388 (2019).
- 8. Prediction of gastric cancer development by serum pepsinogen test and Helicobacter pylori seropositivity in eastern Asians: a systematic review and meta-analysis. PLoS ONE 9(10), e109783 (2014).
- 9. . The significance of OLGA and OLGIM staging systems in the risk assessment of gastric cancer: a systematic review and meta-analysis. Gastric Cancer 21(4), 579–587 (2018).
- 10. . Markers of gastric intestinal metaplasia under digital chromoendoscopy: systematic review and meta-analysis. Eur. J. Gastroenterol. Hepatol. 33(4), 470–478 (2021).
- 11. A new method of diagnosing gastric intestinal metaplasia: narrow-band imaging with magnifying endoscopy. Endoscopy 38(8), 819–824 (2006).
- 12. . OLGA- and OLGIM-based staging of gastritis using narrow-band imaging magnifying endoscopy. Dig. Endosc. 27(7), 734–41 (2015).
- 13. A multicenter prospective study of the real-time use of narrow-band imaging in the diagnosis of premalignant gastric conditions and lesions. Endoscopy 48(8), 723–730 (2016). •• Proposed the concept of endoscopic grading of gastric intestinal metaplasia (EGGIM) to identify areas of gastric intestinal metaplasia (GIM) using non-magnification digital chromoendoscopy and then carrried out risk stratification of patients with GIM, finding the method to be feasible and accurate, with narrow-band imaging (NBI), blue light imaging (BLI) and linked color imaging (LCI) all showing good operability.
- 14. P.13.2 Do we really need biopsy to diagnose colorectal cancer? Dig. Liver Dis. 48(2), e189 (2016).
- 15. Light-NBI to identify high-risk phenotypes for gastric adenocarcinoma: do we still need biopsies? Scand. J. Gastroenterol. 51(4), 501–506 (2016).
- 16. Endoscopic grading of gastric intestinal metaplasia on risk assessment for early gastric neoplasia: can we replace histology assessment also in the west? Gut 69(10), 1762–1768 (2020).
- 17. Classification and grading of gastritis. The updated Sydney system. International Workshop on the Histopathology of Gastritis, Houston 1994. Am. J. Surg. Pathol. 20(10), 1161–1181 (1996).
- 18. QUADAS-2: a revised tool for the quality assessment of diagnostic accuracy studies. Ann. Intern. Med. 155(8), 529–536 (2011).
- 19. Ability of blue laser imaging with magnifying endoscopy for the diagnosis of gastric intestinal metaplasia. Lasers Med. Sci. 33(8), 1757–1762 (2018).
- 20. Narrow-band imaging with magnifying endoscopy is accurate for detecting gastric intestinal metaplasia. World. J. Gastroenterol. 19(17), 2668–2675 (2013).
- 21. Diagnosis of gastric intestinal metaplasia with confocal laser endomicroscopy in vivo: a prospective study. Endoscopy 40(7), 547–553 (2008).
- 22. Marginal turbid band and light blue crest, signs observed in magnifying narrow-band imaging endoscopy, are indicative of gastric intestinal metaplasia. BMC Gastroenterol. 12, 169 (2012).
- 23. Comprehensive investigation of areae gastricae pattern in gastric corpus using magnifying narrow band imaging endoscopy in patients with chronic atrophic fundic gastritis. Helicobacter 17(3), 224–231 (2012).
- 24. Topographic differences in gastric micromucosal patterns observed by magnifying endoscopy with narrow band imaging. J. Gastroenterol. Hepatol. 26(3), 477–483 (2011).
- 25. AGA technical review on gastric intestinal metaplasia – natural history and clinical outcomes. Gastroenterology 158, 705–731.e5 (2020).
- 26. Magnification chromoendoscopy for the diagnosis of gastric intestinal metaplasia and dysplasia. Gastrointest. Endosc. 57(4), 498–504 (2003).
- 27. Endoscopic patterns of gastric mucosa and its clinicopathological significance. World. J. Gastroenterol. 9(11), 2552–2556 (2003).
- 28. Gastric intestinal metaplasia assessment between linked color imaging based on endoscopy and pathology. Scand. J. Gastroenterol. 56(1), 103–110 (2021).
- 29. Endoscopic grading of gastric intestinal metaplasia (EGGIM): a multicenter validation study. Endoscopy 51(6), 515–521 (2019).
- 30. . NOTES: current status and new horizons. Gastroenterology 142(4), 704–710.e1 (2012).
- 31. Artificial intelligence in the diagnosis of gastric precancerous conditions by image-enhanced endoscopy: a multicenter, diagnostic study (with video). Gastrointest. Endosc. 94(3), 540–548.e4 (2021).