Narrow-band imaging for the detection of early gastric cancer among high risk patients: a meta-analysis

Aims Narrow-band imaging (NBI) is extensively used to enhance the vascular and mucosal pattern characterisation along with near-focus magnification. There are currently 3 generations available. Its effectiveness in detecting malignant lesions among high-risk patients during gastroscopy has not been evaluated. We aimed to perform a systematic review and meta-analysis of the literature comparing NBI and white light imaging (WLI) in patients with a history of gastric cancer or red-flag symptoms including anaemia and weight loss [1] [2] [3].

Methods We performed literature searches in MEDLINE and Cochrane Library for randomized-controlled trials (RCTs) published as full papers in English language evaluating NBI versus WLI among high-risk patients up to October 2024. The primary outcome was gastric neoplasm detection rate (GNDR). Secondary outcomes were the focal gastric lesion detection rate -including adenomas, intestinal metaplasia and gastric cancer- and the positive predictive value. The effect size on study outcomes was calculated using random effect model and it is shown as RR (95%CI).

Results We identified three studies enrolling a total of 6003 patients. Two studies utilized second generation NBI while one study used third generation NBI. For WLI, two studies used high definition WLI and one employed standard WLI. Overall, the use of NBI was not associated with increased GNDR compared to WLI [2.72% vs. 2.39%; RR (95%CI)=1.14(0.78-1.66); P=0.51; Ι2=16%]. Focal gastric lesion detection rates were also not statistically significant between the two groups [14.73% vs. 15.50%; RR (95%CI)=1.05 (0.72-1.52); P=0.81; Ι2=87%]. Available data from two studies showed no significant difference in positive predictive value between NBI and WLI [29.56% vs. 20.56%; RR (95%CI)=1.29 (0.84-1.99); P=0.25; Ι2=61%].

Conclusions NBI does not demonstrate superiority in gastric cancer detection rates compared to WLI among high-risk patients. Additionally, the focal gastric lesion detection rates and positive predictive values were similar in both groups.

 

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Conflicts of Interest

Authors do not have any conflict of interest to disclose.

• References

• 1 adota T, Abe S, Uedo N. et al. Comparison of Effective Imaging Modalities for Detecting Gastric Neoplasms: A Randomized 3-Arm Phase II Trial. Am J Gastroenterol 2024; 119 (10): 2010-2018
• 2 Yoshida N, Doyama H, Yano T. et al. Early gastric cancer detection in high-risk patients: a multicentre randomised controlled trial on the effect of second-generation narrow band imaging. Gut 2021; 70 (01): 67-75
• 3 Kadota T, Abe S, Uedo N. et al. Comparison of Effective Imaging Modalities for Detecting Gastric Neoplasms: A Randomized 3-Arm Phase II Trial. Am J Gastroenterol 2024; 119 (10): 2010-2018

Publikationsverlauf

Artikel online veröffentlicht:
27. März 2025