Background Image-enhanced endoscopy (IEE) improves the accuracy of endoscopic diagnosis. We aimed to assess the value of IEE for gastric preneoplastic conditions and neoplastic lesions. Methods Medline and Embase were searched until December 2018. Studies allowing calculation of diagnostic measures were included. Risk of bias and applicability were assessed using QUADAS-2. Subgroup analysis was performed to explore heterogeneity. Results 44 studies met the inclusion criteria. For gastric intestinal metaplasia (GIM), narrow-band imaging (NBI) obtained a pooled sensitivity and specificity of 0.79 (95 %CI 0.72–0.85) and 0.91 (95 %CI 0.88–0.94) on per-patient basis; on per-biopsy basis, it was 0.84 (95 %CI 0.81–0.86) and 0.95 (95 %CI 0.94–0.96), respectively. Tubulovillous pattern was the most accurate marker to detect GIM and it was effectively assessed without high magnification. For dysplasia, NBI showed a pooled sensitivity and specificity of 0.87 (95 %CI 0.84–0.89) and 0.97 (95 %CI 0.97–0.98) on per-biopsy basis. The use of magnification improved the performance of NBI to characterize early gastric cancer (EGC), especially when the vessel plus surface (VS) classification was applied. Regarding other technologies, trimodal imaging also obtained a high accuracy for dysplasia (sensitivity 0.93 [95 %CI 0.85–0.98], specificity 0.98 [95 %CI 0.92–1.00]). For atrophic gastritis, no specific pattern was noted and none of the technologies reached good diagnostic yield. Conclusion NBI is highly accurate for GIM and dysplasia. The presence of tubulovillous pattern and the VS classification seem to be useful to detect GIM and characterize EGC, respectively. These features should be used in current practice and to standardize endoscopic criteria for other technologies.

Introduction: We aimed to report the impact of pandemic lockdown period on the treatment and prognosis of superficial gastrointestinal neoplastic lesions. Methods: a survey was completed by 11 centers from 4 continents, regarding postponements during early lockdown period of the pandemic, and the same period in 2019. Results: In 2020, 55% of the scheduled procedures were deferred which was eleven times higher than those in 2019, and the main reasons were directly related to COVID-19. In countries highly affected, this proportion rose to 76% versus 26% in those with less impact. Despite the absolute reduction, the relative distribution 2019 vs 2020 was similar, only exception was duodenal lesions (affected by a 92% reduction in mucosectomies). Although it is expected that the majority of postponements will not affect the stage (based on results from biopsies and/or endoscopic appearance), 3% may probably require surgery. Conclusions: The lockdown period caused by SARS-CoV-2 pandemic led to a substantial reduction in endoscopic resections of neoplastic lesions. Nevertheless, based on clinical judgment the planned median delay will not worsen their prognosis.

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