1
|
Lee JG, Yoo IK, Yeniova AO, Lee SP. The Diagnostic Performance of Linked Color Imaging Compared to White Light Imaging in Endoscopic Diagnosis of Helicobacter pylori Infection: A Systematic Review and Meta-Analysis. Gut Liver 2024; 18:444-456. [PMID: 37800315 PMCID: PMC11096912 DOI: 10.5009/gnl230244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Revised: 07/25/2023] [Accepted: 08/02/2023] [Indexed: 10/07/2023] Open
Abstract
Background/Aims Recognizing Helicobacter pylori infection during endoscopy is important because it can lead to the performance of confirmatory testing. Linked color imaging (LCI) is an image enhancement technique that can improve the detection of gastrointestinal lesions. The purpose of this study was to compare LCI to conventional white light imaging (WLI) in the endoscopic diagnosis of H. pylori infection. Methods We conducted a comprehensive literature search using PubMed, Embase, and the Cochrane Library. All studies evaluating the diagnostic performance of LCI or WLI in the endoscopic diagnosis of H. pylori were eligible. Studies on magnifying endoscopy, chromoendoscopy, and artificial intelligence were excluded. Results Thirty-four studies were included in this meta-analysis, of which 32 reported the performance of WLI and eight reported the performance of LCI in diagnosing H. pylori infection. The pooled sensitivity and specificity of WLI in the diagnosis of H. pylori infection were 0.528 (95% confidence interval [CI], 0.517 to 0.540) and 0.821 (95% CI, 0.811 to 0.830), respectively. The pooled sensitivity and specificity of LCI in the diagnosis of H. pylori were 0.816 (95% CI, 0.790 to 0.841) and 0.868 (95% CI, 0.850 to 0.884), respectively. The pooled diagnostic odds ratios of WLI and LCI were 15.447 (95% CI, 8.225 to 29.013) and 31.838 (95% CI, 15.576 to 65.078), respectively. The areas under the summary receiver operating characteristic curves of WLI and LCI were 0.870 and 0.911, respectively. Conclusions LCI showed higher sensitivity in the endoscopic diagnosis of H. pylori infection than standard WLI.
Collapse
Affiliation(s)
- Jae Gon Lee
- Department of Internal Medicine, Hallym University Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Hwaseong, Korea
| | - In Kyung Yoo
- Department of Gastroenterology, CHA Bundang Medical Center, CHA University College of Medicine, Seongnam, Korea
| | - Abdullah Ozgur Yeniova
- Division of Gastroenterology, Department of Internal Medicine, Tokat Gaziosmanpasa University School of Medicine, Tokat, Turkey
| | - Sang Pyo Lee
- Department of Internal Medicine, Hallym University Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Hwaseong, Korea
| | | |
Collapse
|
2
|
Garcés-Durán R, Llach J, Da Fieno A, Córdova H, Fernández-Esparrach G. Diagnóstico endoscópico de la infección por H. pylori. GASTROENTEROLOGÍA Y HEPATOLOGÍA 2022; 46:483-488. [DOI: 10.1016/j.gastrohep.2022.09.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Revised: 09/15/2022] [Accepted: 09/26/2022] [Indexed: 11/07/2022]
|
3
|
Yu F, Qin S, Wang S, Wang J. Regular arrangement of collecting venules (RAC) as an endoscopic marker for exclusion of Helicobacter pylori (H. pylori) infection: A systematic review and meta-analysis. Int J Clin Pract 2021; 75:e14548. [PMID: 34137145 DOI: 10.1111/ijcp.14548] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Accepted: 06/16/2021] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Helicobacter pylori (H. pylori) is the most common cause of gastric cancer. Growing evidence suggests that the regular arrangement of collecting venules (RAC) can be used as an endoscopic marker to diagnose H. pylori infection. However, data on the diagnostic accuracy of RAC for H. pylori infection are conflicting. We performed a systematic review and meta-analysis of relevant studies to determine the diagnostic accuracy and clinical utility of RAC for the diagnosis of H. pylori infection. METHODS We systematically searched PubMed, Embase, Web of Science and the Cochrane Library between inception and Oct 29, 2020, for studies that assessed the diagnostic accuracy of RAC for H. pylori infection. RESULTS The literature search yielded 2921 non-duplicated screened titles, of which 58 underwent full-text review. Fifteen studies, representing a total of 6621 patients, met the inclusion criteria. The area under the summary receiver operating characteristic curve was 0.98 (95% CI 0.96-0.99). The pooled estimates for RAC were 0.98 (95% CI 0.95-0.99) for sensitivity and 0.75 (95% CI 0.54-0.88) for specificity. The pooled positive likelihood ratio (PLR) and negative likelihood ratio (NLR) were 3.8 (95% CI 1.9-7.7) and 0.03 (95% CI 0.02-0.07), respectively. CONCLUSIONS RAC can be used as an endoscopic marker for exclusion of H. pylori infection. However, it cannot be recommended as a single indicator for the confirmation of H. pylori infection. The conclusion of this study should be treated with caution because significant heterogeneity exists between the evaluated studies.
Collapse
Affiliation(s)
- Fan Yu
- Department of Gastroenterology and Hepatology, China-Japan Union Hospital of Jilin University, Changchun, China
| | - Shaoyou Qin
- Department of Gastroenterology and Hepatology, China-Japan Union Hospital of Jilin University, Changchun, China
| | - Song Wang
- Department of Urology, The First Hospital of Jilin University, Changchun, China
| | - Jiangbin Wang
- Department of Gastroenterology and Hepatology, China-Japan Union Hospital of Jilin University, Changchun, China
| |
Collapse
|
4
|
Glover B, Teare J, Patel N. Assessment of Helicobacter pylori status by examination of gastric mucosal patterns: diagnostic accuracy of white-light endoscopy and narrow-band imaging. BMJ Open Gastroenterol 2021; 8:bmjgast-2021-000608. [PMID: 34353822 PMCID: PMC8344320 DOI: 10.1136/bmjgast-2021-000608] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Accepted: 07/04/2021] [Indexed: 02/07/2023] Open
Abstract
Objectives Helicobacter pylori infection is a common cause of chronic gastritis worldwide and an established risk factor for developing gastric malignancy. The endoscopic appearances predicting H. pylori status are an ongoing area of research, as are their diagnostic accuracies. This study aimed to establish the diagnostic accuracy of several mucosal features predictive of H. pylori negative status and formulate a simple prediction model for use at the time of endoscopy. Design Patients undergoing high-definition upper gastrointestinal (GI) endoscopy without magnification were recruited prospectively. During the endoscopy, the presence or absence of specific endoscopic findings was noted. Sydney protocol biopsies were used as the diagnostic reference standard, and urease test if taken. The results informed a logistic regression model used to produce a simple diagnostic approach. This model was subsequently validated using a further cohort of 30 patients. Results 153 patients were recruited and completed the study protocol. The prevalence of active H. pylori infection was 18.3% (28/153). The overall diagnostic accuracy of the simple prediction model was 80.0%, and 100% of patients with active H. pylori infection were correctly classified. The presence of regular arrangement of collecting venules (RAC) showed a positive predictive value for H. pylori naïve status of 90.7%, rising to 93.6% for patients under the age of 60. Conclusion A simple endoscopic model may be accurate for predicting H. pylori status of a patient, and the need for biopsy-based tests. The presence of RAC in the stomach is an accurate predictor of H. pylori negative status, particularly in patients under the age of 60. Trial registration number The study was registered with ClinicalTrials.gov, No. NCT02385045.
Collapse
Affiliation(s)
- Ben Glover
- Surgery and Cancer, Imperial College London, London, UK
| | - Julian Teare
- Surgery and Cancer, Imperial College London, London, UK
| | - Nisha Patel
- Surgery and Cancer, Imperial College London, London, UK
| |
Collapse
|
5
|
Garcés-Durán R, Galdín-Ferreyra M, Delgado-Guillena PG, Cuatrecasas M, Córdova H, García-Rodríguez A, Rodrigo-Calvo MT, Jimeno-Ramiro M, Araujo IK, Ginès A, Llach J, Fernandez-Esparrach G. Diagnosis of Helicobacter pylori Infection by the Arrangement of Collecting Venules Using White Light Endoscopy: Evaluation of Interobserver Agreement. Dig Dis 2021; 40:376-384. [PMID: 34348294 DOI: 10.1159/000518100] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Accepted: 06/25/2021] [Indexed: 02/02/2023]
Abstract
BACKGROUND Regular arrangement of collecting venules (RAC) in gastric mucosa accurately identifies patients without Helicobacter pylori (H pylori) infection. The aim of our study was to evaluate the reproducibility of RAC using white light endoscopy without magnification, in a European country, and to assess the impact of proton pump inhibitors (PPIs). METHODS A multicenter prospective study with image capture of the distal lesser gastric curvature and gastric biopsies was performed. The presence of starfish-like minute points regularly distributed throughout lesser curvature was considered as RAC positive (RAC+). A set of 20 images was used for the training phase and inter and intra-observer agreements were calculated. RESULTS 174 patients were included and 85 (48.9%) were taking PPIs. Kappa values for interobserver and intra-observer agreements were substantial (0.786) and excellent (0.906), respectively. H. pylori infection was diagnosed in 29 patients (16.7%): 10/85 with PPIs and 19/89 without PPIs (11.8% vs. 21.3%; p = 0.09). All RAC + patients were free of H. pylori infection, with a sensitivity and negative predictive value of 100%, regardless of PPI intake. CONCLUSION The endoscopic diagnosis of H. pylori by RAC is an easy-to-learn and highly reproducible technique, even with PPI intake. Our results warrant RAC as a real-time diagnostic method for H. pylori-negative infection in Western practice.
Collapse
Affiliation(s)
- Rodrigo Garcés-Durán
- Endoscopy Unit, ICMDiM, Hospital Clínic of Barcelona, University of Barcelona, Barcelona, Spain
| | | | | | - Miriam Cuatrecasas
- Pathology Department, Hospital Clínic, University of Barcelona, Barcelona, Spain.,IDIBAPS, Barcelona, Spain.,CIBEREHD, Barcelona, Spain
| | - Henry Córdova
- Endoscopy Unit, ICMDiM, Hospital Clínic of Barcelona, University of Barcelona, Barcelona, Spain.,IDIBAPS, Barcelona, Spain.,CIBEREHD, Barcelona, Spain
| | - Ana García-Rodríguez
- Endoscopy Unit, ICMDiM, Hospital Clínic of Barcelona, University of Barcelona, Barcelona, Spain
| | | | | | - Isis Karina Araujo
- Endoscopy Unit, ICMDiM, Hospital Clínic of Barcelona, University of Barcelona, Barcelona, Spain
| | - Angels Ginès
- Endoscopy Unit, ICMDiM, Hospital Clínic of Barcelona, University of Barcelona, Barcelona, Spain.,IDIBAPS, Barcelona, Spain.,CIBEREHD, Barcelona, Spain
| | - Josep Llach
- Endoscopy Unit, ICMDiM, Hospital Clínic of Barcelona, University of Barcelona, Barcelona, Spain.,IDIBAPS, Barcelona, Spain
| | - Gloria Fernandez-Esparrach
- Endoscopy Unit, ICMDiM, Hospital Clínic of Barcelona, University of Barcelona, Barcelona, Spain.,IDIBAPS, Barcelona, Spain.,CIBEREHD, Barcelona, Spain
| |
Collapse
|
6
|
Glover B, Teare J, Ashrafian H, Patel N. The endoscopic predictors of Helicobacter pylori status: a meta-analysis of diagnostic performance. Ther Adv Gastrointest Endosc 2020; 13:2631774520950840. [PMID: 33150333 PMCID: PMC7586493 DOI: 10.1177/2631774520950840] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Accepted: 07/08/2020] [Indexed: 12/18/2022] Open
Abstract
Objective: The endoscopic findings associated with Helicobacter pylori–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. Data sources: The databases of MEDLINE and Embase, clinicalTrials.gov and the Cochrane Library were systematically searched for relevant studies from October 1999 to October 2019. Methods: 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 H pylori status. Results: Meta-analysis included 4380 patients in 15 studies. The most significant predictor of an H pylori-naïve status was a regular arrangement of collecting venules (diagnostic odds ratio 55.0, sensitivity 78.3%, specificity 93.8%). Predictors of active H pylori 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 H pylori eradication (99.0%), but poor specificity (13.0%). Conclusion: The regular arrangement of collecting venules, mucosal oedema, diffuse redness and map-like redness are important endoscopic findings for determining H pylori status. This meta-analysis provides a tentative basis for developing future endoscopic classification systems.
Collapse
|
7
|
Li L, Jing J, Gao H, Zhang C, Lou H, Pan W. Regular arrangement of collecting venules under endoscopy for predicting a Helicobacter pylori-negative stomach: A systematic review and meta-analysis. GASTROENTEROLOGIA Y HEPATOLOGIA 2020; 44:286-292. [PMID: 33097281 DOI: 10.1016/j.gastrohep.2020.08.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 08/09/2020] [Accepted: 08/31/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND AND AIMS The regular arrangement of collecting venules (RAC) refers to the appearance of multiple regular tiny veins in the body of the stomach and is considered to be very effective for identifying gastric mucosa with non-Helicobacter pylori infection. This meta-analysis was conducted to systematically evaluate the value of the sign in predicting a Helicobacter pylori-negative stomach and the relevant factors that may affect the performance of this prediction. METHODS Two biomedical databases (PubMed and EMBASE) were systematically searched through April 20, 2020. The pooled sensitivity, specificity, positive likelihood ratio (PLR), negative likelihood ratio (NLR), diagnostic odds ratio (DOR) and area under the SROC curve (AUC) were calculated. RESULTS Fourteen articles with 4070 patients were included. The pooled sensitivity, specificity, PLR, NLR, DOR and AUC for the RAC in predicting non-Hp infection were 0.80 (0.67-0.89), 0.97 (0.93-0.98), 24.8 (12.2-50.8), 0.21 (0.12-0.36), 120 (47-301) and 0.97 (0.19-1.00), respectively. CONCLUSIONS The RAC is a valuable endoscopic feature for the prediction of patients without Hp infection.
Collapse
Affiliation(s)
- Lunan Li
- BengBu Medical College, Bengbu, Anhui, China; Department of Gastroenterology, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, Hangzhou, Zhejiang, China
| | - Jiyong Jing
- Department of Gastroenterology, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, Hangzhou, Zhejiang, China
| | - Huiqin Gao
- BengBu Medical College, Bengbu, Anhui, China
| | - Chenjing Zhang
- Department of Gastroenterology, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, Hangzhou, Zhejiang, China
| | - Haifang Lou
- Department of Gastroenterology, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, Hangzhou, Zhejiang, China
| | - Wensheng Pan
- Department of Gastroenterology, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, Hangzhou, Zhejiang, China.
| |
Collapse
|
8
|
Garcés-Durán R, García-Rodríguez A, Córdova H, Cuatrecasas M, Ginès À, González-Suárez B, Araujo I, Llach J, Fernández-Esparrach G. Association between a regular arrangement of collecting venules and absence of Helicobacter pylori infection in a European population. Gastrointest Endosc 2019; 90:461-466. [PMID: 31108089 DOI: 10.1016/j.gie.2019.05.027] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Accepted: 05/11/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND AND AIMS Helicobacter pylori is the major cause of gastritis and gastritis-associated diseases. Detection of a regular arrangement of collecting venules (RAC) in the lesser gastric curvature correlates with negative H pylori status with a sensitivity and negative predictive value (NPV) higher than 90% in Asian countries. The aim of the study was to evaluate the value of RAC as a diagnostic method of H pylori infection in a European population. METHODS A prospective study with high-definition endoscopes without magnification was performed by 3 endoscopists. The presence of starfish-like minute points regularly distributed throughout the lesser curvature of the gastric body was considered RAC positive (RAC+). Gastric biopsies were performed during the procedure for H pylori diagnosis. RESULTS One hundred forty patients were included from February 2017 to May 2018. The prevalence of H pylori infection was 31% and 47 of 140 patients (34%) were RAC+; 13 of 23 patients in whom H pylori was eradicated were RAC+. The mean age of RAC+ patients was lower (44.4 vs 52.4 years, P = .004) and they had less- significant endoscopic findings (9; 19.1% vs 38; 80.9%; P = .017). Gender, use of nonsteroidal anti-inflammatory drugs, antithrombotic or anticoagulants treatments, and a history of H pylori eradication did not show differences in the RAC pattern. The absence of RAC was associated with H pylori infection in 47.3% (44/93) of cases. In contrast, all RAC+ patients were free of H pylori infection, with sensitivity and NPV of 100% for the exclusion of H pylori infection. CONCLUSION The presence of RAC+ in the lesser curvature evaluated with high-definition endoscopy can accurately identify patients without H pylori.
Collapse
Affiliation(s)
- Rodrigo Garcés-Durán
- Endoscopy Unit, ICMDiM, IDIBAPS, CIBEREHD, Hospital Clínic, University of Barcelona, Barcelona, Catalonia
| | - Ana García-Rodríguez
- Endoscopy Unit, ICMDiM, IDIBAPS, CIBEREHD, Hospital Clínic, University of Barcelona, Barcelona, Catalonia
| | - Henry Córdova
- Endoscopy Unit, ICMDiM, IDIBAPS, CIBEREHD, Hospital Clínic, University of Barcelona, Barcelona, Catalonia
| | - Miriam Cuatrecasas
- Pathology Department, CDB, Hospital Clínic, IDIBAPS, Universitat de Barcelona, Banc de Tumors Biobanc Clínic-IDIBAPS, Barcelona, Catalonia, Spain
| | - Àngels Ginès
- Endoscopy Unit, ICMDiM, IDIBAPS, CIBEREHD, Hospital Clínic, University of Barcelona, Barcelona, Catalonia
| | - Begoña González-Suárez
- Endoscopy Unit, ICMDiM, IDIBAPS, CIBEREHD, Hospital Clínic, University of Barcelona, Barcelona, Catalonia
| | - Isis Araujo
- Endoscopy Unit, ICMDiM, IDIBAPS, CIBEREHD, Hospital Clínic, University of Barcelona, Barcelona, Catalonia
| | - Josep Llach
- Endoscopy Unit, ICMDiM, IDIBAPS, CIBEREHD, Hospital Clínic, University of Barcelona, Barcelona, Catalonia
| | - Gloria Fernández-Esparrach
- Endoscopy Unit, ICMDiM, IDIBAPS, CIBEREHD, Hospital Clínic, University of Barcelona, Barcelona, Catalonia
| |
Collapse
|
9
|
|