Meta-Analysis
Copyright ©The Author(s) 2018.
World J Gastroenterol. Mar 14, 2018; 24(10): 1167-1180
Published online Mar 14, 2018. doi: 10.3748/wjg.v24.i10.1167
Table 1 Study characteristics
AuthorsYearAbstract/articleTechnologyNumber of endoscopistsStudy designReal time vs Image reviewNo. of PatientsNo. of PolypsMucosal classification method
Virtual Chromoendoscopy
Cassinotti et al[22]2016Abstracti-scan HD/Single centre/prospective cohortReal time40287Kudo PP + other endoscopic features
Prospective cohort
Efthymiou et al[21]2013ArticleNBI HD2Single centre/prospective cohortReal time44121Kudo PP + low level magnification
Van den broek et al[23]2011ArticleNBI HD4Single centre/randomized cross-overReal time48153Kudo PP
Cassinotti et al[24]2015AbstractFICE HD1Single centre/randomized parallelReal time41261Kudo PP
Cassinotti et al[25]2015AbstractFICE HD1Single centre/prospective cohortReal time59205Kudo PP
Dye-based Chromoendoscopy
Carballal et al[26]2016ArticleIC 0.4% SD/HD15Multi-centre/prospective cohortReal time350595Kudo PP + 10 other items
1Buchner et al[27]2016AbstractMB 0.1% HD/Prospective cohortReal time2221/
2Wanders et al[20]2016ArticleMB 0.1% SD> 1Multi-centre/prospective cohortReal time6166Kudo PP
Munoz et al [28]2016AbstractIC 0.2%-0.4% HD> 1Multi-centre/retrospective cohortReal time243953Kudo PP
Wanders et al[29]2015ArticleMB 0.1% or IC 0.3%17Multi-centre/retrospective questionnaireImage review/30/
3Hlavaty et al [18]2011ArticleIC 0.4% SD2Single centre/prospective cohortReal time30100Kudo PP
Confocal Laser Endomicroscopy
2Wanders et al[20]2016ArticleiCLE> 1Multi-centre/prospective cohortReal time6160Mainz criteria
Dlugosz et al[30]2016ArticlepCLE1 endoscopist (2 reviewed images)Single centre/retrospective cohortImage review69644Crypt + vessel architecture
1Buchner et al[27]2016AbstractpCLE/Prospective cohortReal time2220Miami classification
Freire et al[31]2014ArticleiCLE1Single centre/randomized trialReal time72104Mainz criteria
Rispo et al[32]2012ArticlepCLE1Single centre/prospective cohortReal time5115De Palma classification
Shahid et al[33]2011AbstractpCLE3 reviewed imagesSingle centre/retrospective cohortImage review2561/
3Hlavaty et al[18]2011ArticleiCLE2Single centre/prospective cohortReal time3068Mainz classification
4Van den broek et al[19]2011ArticlepCLE4 endoscopists (2 reviewing images)Single centre/retrospective cohortImage review2248Crypt + vessel architecture
Keisslich et al[34]2007ArticleiCLE/Single centre/randomized trialReal time80134Mainz classification
Magnification endoscopy
Nishiyama et al[35]2016ArticleNBI5 reviewed imagesSingle centre/retrospective cohortImage review2733Surface + vessel patterns
4Van den broek et al[19]2011ArticleNBI4Single centre/prospective cohortReal time2248Kudo PP + vascular patterns
Van den broek et al[36]2008ArticleNBI3Single centre/randomized trialReal time5098Kudo PP
Matsumoto et al[37]2007ArticleNBI1Single centre/prospective cohortReal time46296Surface structure
Keisslich et al[38]2003ArticleMB 0.1%1Single centre/randomized trialReal time84118Kudo PP
Studies using combined technologies
Bisschops et al[39]2013AbstractDye-based chromo/NBI10 reviewed imagesMulti-centre / Retrospective cohortImage review2750Kudo PP
List of studies included in meta-analysis and displayed according to technology type. PP: Pit pattern; /: Data missing.
1Two different technologies from same abstract;
2Two different technologies from same article;
3Two different technologies from same article;
4Two different technologies from the same article.
Table 2 quality assessment of diagnostic accuracy studies 2 for each study
Cassinotti et al[22] 2016Efthymiou et al[21]2013Van den broek et al[23]2011Cassinottiet al[24]2015Cassinottiet al[25]2015Carballel et al[26]2016Buchner et al[27]2016Wanders et al[20]2016Munoz et al[28]2016Wanders et al[29]2015Hlavaty et al[18]2011Dlugosz et al[30]2016Freireet al[31]2014Rispoet al[32]2012Shahidet al[33]2011Van den broek et al[19] 2011Keisslichet al[34]2007Nishiyamaet al[35]2016Van den Broek et al[36]2008Matsumotoet al[37]2007Keisslich et al[38]2003Bisschopset al[39]2013
DOMAIN 1
Patient selection
Risk of bias
Could selection of patients introduced bias?LLLLLLULLHULLLHHLHLLLH
Concerns regarding applicability
Concern included patients don’t match review question?LLLLLLLLLLLLLLLLLLLLLL
DOMAIN 2
Index test
Risk of bias
Conduct or interpretation of index test introduced bias?LLLLLLLLUHHHLLHHLHLLLH
Concerns regarding applicability
Concern index test, its conduct or interpretation differs from review question?LLLLLLLLLLLLLLLLLLLLLL
DOMAIN 3
Reference standard
Risk of bias
Could reference standard, conduct or interpretation have introduced bias?UULUUUULUULLLLULLULLLU
Concerns regarding applicability
Concern target condition as defined by reference standard not match review question?LLLLLLLLLLLLLLLLLLLLLL
DOMAIN 4
Flow and timing
Risk of bias
Could patient flow introduced bias?ULHUULULUHHULLHHLHLLLH
L: Low risk; H: High risk; U: Unclear.
Table 3 Accuracy of the different technologies
Analysis groupsNo. of studiesPooled estimates (95%CI)Likelihood ratios (95%CI)Diagnostic odds ratio (95%CI)Area under SROC curve (95%CI)
SensitivitySpecificityLHR+LHR-DOR
All
VCE50.86 (0.62-0.95)0.87 (0.72-0.95)6.7 (2.6-17.8)0.17 (0.05-0.53)41 (6-297)0.93 (0.90-0.95)
DBC60.67 (0.44-0.84)0.86 (0.72-0.94)4.9 (2.1-11.3)0.38 (0.20-0.73)13 (3-48)0.84 (0.81-0.87)
Magnification50.90 (0.77-0.96)0.87 (0.81-0.91)7.0 (4.6-10.7)0.11 (0.05-0.28)62 (18-209)0.93 (0.91-0.95)
CLE90.87 (0.71-0.95)0.94 (0.87-0.97)14.0 (6.1-32.4)0.14 (0.06-0.33)101 (23-442)0.96 (0.94-0.97)
Real-time
Kudo PP100.78 (0.57-0.91)0.89 (0.80-0.94)6.9 (3.5-13.5)0.24 (0.11-0.55)28 (7-110)0.91 (0.89-0.94)
CLE60.91 (0.66-0.98)0.97 (0.94-0.98)28.4 (13.6-59.1)0.09 (0.02-0.43)322 (41-2529)0.98 (0.97-0.99)
All Kudo PP120.78 (0.61-0.88)0.86 (0.76-0.92)5.5 (2.9-10.1)0.26 (0.14-0.50)21 (7-66)0.89 (0.86-0.92)
All using both real-time and image based studies for the different technologies. Real-time, sub-group analysis with studies using only real time Kudo pit pattern (both VCE and DBC) and real-time CLE. All Kudo PP includes all studies using Kudo pit pattern (real-time and image-based). VCE: Virtual chromoendoscopy; DBC: Dye-based chromoendoscopy; CLE: Confocal laser endomicroscopy; Kudo PP: Kudo pit pattern; LHR+: Positive likelihood ratios; LHR-: Negative likelihood ratios; DOR: Diagnostic odd ratios.