Meta-Analysis
Copyright ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Endosc. Dec 16, 2023; 15(12): 735-744
Published online Dec 16, 2023. doi: 10.4253/wjge.v15.i12.735
Clinical usefulness of linked color imaging in identifying Helicobacter pylori infection: A systematic review and meta-analysis
Yu Zhang, Jing-Zhai Wang, Xuan Bai, Peng-Li Zhang, Qiang Guo
Yu Zhang, Jing-Zhai Wang, Xuan Bai, Peng-Li Zhang, Department of Gastroenterology, The First People’s Hospital of Yunnan Province, Affiliated Hospital of Kunming University of Science and Technology, Kunming 650000, Yunnan Province, China
Yu Zhang, Jing-Zhai Wang, Xuan Bai, Peng-Li Zhang, Qiang Guo, Yunnan Digestive Endoscopy Clinical Medical Center, Kunming 650000, Yunnan Province, China
Qiang Guo, Department of Gastroenterology, The First People’s Hospital of Yunnan Province, Affiliated Hospital of Kunming University of Science and Technology, Kunming 650000, Yunnan Province, China
Author contributions: Guo Q brought the idea of this study; Wang JZ, Bai X, and Zhang PL worked together for literature searching and data analysis; Zhang Y wrote the manuscript.
Supported by Clinical Medical Center of Yunnan Provincial Health Commission, No. 2020LCZXKF-XH05 and 2021LCZXXF-XH03; Young Academic Talents Cultivation Program of Yunnan Province, No. 202205AC160070.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Qiang Guo, MD, Chief Physician, Department of Gastroenterology, The First People’s Hospital of Yunnan Province, Affiliated Hospital of Kunming University of Science and Technology, No. 157 Jinbi Road, Kunming 650000, Yunnan Province, China. gqkj003@sina.com
Received: August 29, 2023
Peer-review started: August 29, 2023
First decision: October 10, 2023
Revised: October 31, 2023
Accepted: November 24, 2023
Article in press: November 24, 2023
Published online: December 16, 2023
ARTICLE HIGHLIGHTS
Research background

Diagnosis of Helicobacter pylori (H. pylori) infection is a critical step in assessing the risk of chronic atrophic gastritis, intestinal metaplasia, and H. pylori related gastric cancer. Eradication therapy of H. pylori appears to reduce the incidence of new gastric cancers. Therefore, accurate diagnosis of active H. pylori infection by using endoscopy is essential for the diagnosis and treatment of gastric cancer.

Research motivation

Linked color imaging (LCI) is a novel endoscopic modality recently introduced. Compared to the common white light imaging (WLI), the mucosal lesions in red or white color seen on LCI endoscopy are more visible, which makes it easier to identify early gastric cancer. However, the detection rate of H. pylori with LCI compared to WLI remains to be evaluated.

Research objectives

The diagnostic value of LCI compared with WLI for H. pylori activity was assessed by meta-analysis, to provide evidence for expanding the clinical application of LCI endoscopy.

Research methods

PubMed, Embase, Embase, and Cochrane Library databases were searched for literature related to LCI and WLI diagnosis of H. pylori. The “midas” command of Stata 15.0 was used to fit the two-variable mixed-effect model. The point estimates of the sensitivity, specificity, likelihood ratio, and diagnostic ratio were combined to draw the comprehensive subject working characteristics [symmetric receiver operator characteristic (SROC)], and area under the curve (AUC) and its 95% confidence interval (CI) were calculated. The Deek’s funnel plot was used to determine publication bias, and Q statistics. I2 statistics were used to determine whether there was heterogeneity between studies.

Research results

In this study, 94 articles were initially searched, including 25 in PubMed, 16 in Embase, 19 in Cochrane, and 34 in Web of Science, and 7 research articles were ultimately screened. In WLI diagnosis, the probability of confirming H. pylori infection was 70%. In the case of negative results, the probability of H. pylori infection was 34%. The diagnostic odds ratio (DOR) was 5 (95%CI: 2-9), and SROC was 0.75 (95%CI: 0.71-0.78). In LCI diagnosis, the probability of diagnosis of H. pylori infection was 82%. In the negative case, the probability of H. pylori infection was 15%. The DOR was 26 (95%CI: 13-52) and SROC was 0.87 (95%CI: 0.84-0.90).

Research conclusions

LCI improves the diagnostic accuracy of H. pylori infection as well as H. pylori-associated gastric mucosal lesions, which anticipates that LCI alone, rather than WLI, may be applied in the future to screen for gastric disease.

Research perspectives

The screening strategy of LCI followed by magnifying image-enhanced endoscopy may theoretically have better clinical perspectives in early cancer diagnosis.