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

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.

Diagnostic Methods for <i>Helicobacter pylori</i>

“…The main endoscopic methods for diagnosing H. pylori infection are conventional white light imaging and magnification narrow band imaging (NBI). The linked-color imaging technique is a recent endoscopic method, which clearly shows slight color differences caused by pathological changes in the mucosa of the digestive tract [26, 27]. Oesophago-Gastro-Duodenoscopy should be considered in patients with dyspeptic symptoms, particularly in populations with a low prevalence of H. pylori and when alarm symptoms are present such as weight loss, dysphagia, apparent gastrointestinal bleeding, abdominal mass, or iron deficiency anemia [4].…”