Role of confocal microscopic endoscopy in the diagnosis of gastrointestinal epithelia metaplasia and gastric cancer:a Meta-analysis
Objective To study the diagnostic value of confocal lasser endomicroscopy(CLE)in gastrointestinal ep-ithelial metaplasia(GIM)and gastric cancer by Meta-analysis.Methods The databases of PubMed,Cochrane Library,Web of Science,CNKI,Wanfang Data and Sinomed were searched for related studies published up to Oct.2022,and the quality of the included literatures was evaluated according to QUADAS.The random effect model was used to calcu-late the combined sensitivity,specificity,positive likelihood ratio(PLR),negative likelihood ratio(NLR),diagnostic ratio(DOR)and 95% CI,and the pooled receiver operating characteristic curve(SROC)fitting analysis was performed to calculate the area under the curve.Evaluating heterogeneity caused by non-threshold effect by I2,and if there was ob-vious heterogeneity,further judging the source of heterogeneity by regression score;Deek′s funnel diagram and Fagan diagram were used to evaluate the publication bias and the probability before and after the test.Results In the end,7 articles were included in the GIM group and 6 articles were included in the gastric cancer group.There was high hetero-geneity among the included articles,and there was no threshold effect and publication bias.It was found that the sum-marized sensitivity of GIM and gastric cancer for CLE diagnosis were 0.88 and 0.96,the summarized specificity was 0.93 and 0.94,the PLR was 12.43 and 17.34,the NLR was 0.13 and 0.04,the DOR was 98.96 and 416.87,and the area under SROC was 0.92 and 0.98,respectively.Fagan diagram showed that the probability of GIM was 93% when CLE diagnosed GIM,11% when GIM was excluded,95% when gastric cancer was diagnosed,and 4% when gastric cancer was excluded.Meta-regression analysis found that the heterogeneity of GIM group came from other non-variable factors,and the reason for the large heterogeneity of gastric cancer group came from CLE diagnosis state.Conclusion Based on the results of this Meta-analysis,CLE has good diagnostic value for GIM and gastric cancer,and can be used as an auxiliary tool for clinical diagnosis.
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