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CC BY-NC-ND 4.0 · Endosc Int Open 2023; 11(09): E835-E848
DOI: 10.1055/a-2117-8621
Review

Umbrella systematic review of potential quality indicators for the detection of dysplasia and cancer at upper gastrointestinal endoscopy

Umair Kamran 
1   Gastroenterology, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, United Kingdom of Great Britain and Northern Ireland (Ringgold ID: RIN1731)
,
Abdullah Abbasi
2   Gastroenterology, University Hospitals of North Midlands NHS Trust, Stoke-on-Trent, United Kingdom of Great Britain and Northern Ireland (Ringgold ID: RIN9898)
,
Nosheen Umar
3   Gastroenterology, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, United Kingdom of Great Britain and Northern Ireland (Ringgold ID: RIN1731)
,
Imran Tahir
4   Gastroenterology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom of Great Britain and Northern Ireland (Ringgold ID: RIN1732)
,
Matthew J Brookes
5   Department of Gastroenterology, Royal Wolverhampton NHS Trust, Wolverhampton, United Kingdom of Great Britain and Northern Ireland
6   Research Institute in Healthcare Science, University of Wolverhampton, Wolverhampton, United Kingdom of Great Britain and Northern Ireland (Ringgold ID: RIN8695)
,
Matt Rutter
7   Gastroenterology, University Hospital of North Tees, Stockton on Tees, United Kingdom of Great Britain and Northern Ireland
8   Population Health Sciences Institute, Newcastle University Faculty of Medical Sciences, Newcastle upon Tyne, United Kingdom of Great Britain and Northern Ireland (Ringgold ID: RIN12186)
,
Mimi McCord
9   Heartburn Cancer, Hampshire, United Kingdom of Great Britain and Northern Ireland
,
Nicola J Adderley
10   Institute of Applied Health Research, University of Birmingham, Birmingham, United Kingdom of Great Britain and Northern Ireland (Ringgold ID: RIN1724)
,
Janine Dretzke
11   University of Birmingham, University of Birmingham, Birmingham, United Kingdom of Great Britain and Northern Ireland (Ringgold ID: RIN1724)
,
Nigel Trudgill
1   Gastroenterology, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, United Kingdom of Great Britain and Northern Ireland (Ringgold ID: RIN1731)
12   Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, United Kingdom of Great Britain and Northern Ireland (Ringgold ID: RIN156652)
› Author AffiliationsSupported by: National Institute for Health and Care Research (UK) NIHR 201571
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Abstract

Background and study aims Upper gastrointestinal (UGI) endoscopy lacks established quality indicators. We conducted an umbrella systematic review of potential quality indicators for the detection of UGI cancer and dysplasia.

Methods Bibliographic databases were searched up to December 2021 for systematic reviews and primary studies. Studies reporting diagnostic accuracy, detection rates or the association of endoscopy or endoscopist-related factors with UGI cancer or dysplasia detection were included. AMSTAR2 and JBI checklists were used to assess systematic review and primary study quality. Clinical heterogeneity precluded meta-analysis and findings are summarized narratively.

Results Eight systematic reviews and nine primary studies were included. Image enhancement, especially narrow band imaging, had high diagnostic accuracy for dysplasia and early gastric cancer (pooled sensitivity 0.87 (95% CI 0.84–0.89) and specificity 0.97 (0.97–0.98)). Higher detection rates with longer endoscopy examination times were reported in three studies, but no difference was observed in one study. Endoscopist biopsy rate was associated with increased gastric cancer detection (odds ratio 2.5; 95% confidence interval [CI] 2.1–2.9). Early esophageal cancer (0.17% vs 0.14%, P=0.04) and gastric cancer (0.16% vs 0.12%, P=0.02) detection rates were higher with propofol sedation compared to no sedation. Endoscopies performed by trained endoscopists on dedicated Barrett’s surveillance lists had higher detection rates (8% vs 3%, P<0.001). The neoplasia detection rate during diagnostic endoscopies for Barrett’s esophagus was 7% (95% CI 4%-10%).

Conclusions Image enhancement use, longer examination times, biopsy rate and propofol sedation are potential quality indicators for UGI endoscopy. Neoplasia detection rate and dedicated endoscopy lists are additional potential quality indicators for Barrett’s esophagus

Keywords

Endoscopy Upper GI Tract - Barrett's and adenocarcinoma - Precancerous conditions & cancerous lesions (displasia and cancer) stomach - Diagnosis and imaging (inc chromoendoscopy, NBI, iSCAN, FICE, CLE)

Supporting information



Publication History

Received: 14 September 2022

Accepted after revision: 13 June 2023

Article published online:
15 September 2023

© 2023. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).

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