Evidence review for diagnostic accuracy of endoscopic surveillance techniques

Evidence review for diagnostic accuracy of endoscopic surveillance techniques

Barrett’s oesophagus and stage 1 oesophageal adenocarcinoma

Evidence review D

NICE Guideline, No. 231

London: National Institute for Health and Care Excellence (NICE); 2023 Feb.

ISBN-13: 978-1-4731-5010-2

1. Diagnostic accuracy of endoscopic surveillance techniques

1.1. Review question

What is the diagnostic accuracy of different endoscopic surveillance techniques including high resolution endoscopy and chromoendoscopy?

1.1.1. Introduction

Different techniques of endoscopic surveillance are currently used within clinical practice. It is not known how accurate those techniques are in comparison to what is held as the gold standard or reference for endoscopic surveillance (high resolution white light endoscopy).

1.1.2. Methods and process

This evidence review was developed using the methods and process described in Developing NICE guidelines: the manual. Methods specific to this review question are described in the review protocol in appendix A and the methods document.

Declarations of interest were recorded according to NICE’s conflicts of interest policy.

1.1.3. Summary of the protocol

For full details see the review protocol in Appendix A.

Table 1

PICO characteristics of review question.

1.1.4. Diagnostic evidence

1.1.4.1. Included studies

15 diagnostic accuracy studies were included in the review; ¹^–⁹^, ¹¹^–¹⁶ these are summarised in Table 2 below. Evidence from these studies is summarised in the clinical evidence summary below in Appendix C and references in 1.1.13 References.

The aim of the studies was to assess diagnostic test accuracy in identifying Barrett’s oesophagus with dysplasia or cancer, low grade dysplasia, high grade intraepithelial dysplasia/ neoplasia/ cancer, T1a or T1b neoplasia.

12 studies provided information on the diagnostic accuracy of chromoendoscopy techniques, 1 study provided information on the diagnostic accuracy of endoscopic brushing (brush biopsy). 2 studies provided information on the diagnostic accuracy of artificial intelligence (AI): one study looking at convolutional neural networks and one looking at narrow-bang imaging + AI and white-light imaging +AI.

No evidence was identified for the diagnostic accuracy of trans-nasal endoscopy.

Meta-analysis was not conducted because where two or more studies examined the diagnostic accuracy of the same index test, they looked at different target conditions (e.g. high grade dysplasia or low-grade dysplasia), or reported location based analysis while other studies reported per patient based analysis. Thus, results from these studies are presented individually on a per-study basis. Where studies provided insufficient information to extract 2×2 table data (true positives, true negatives, false positives, false negatives) this has been highlighted for each study in Table 3 and sensitivity and specificity measures were extracted as reported in the paper. Where confidence intervals were not available to assess imprecision in the effect measures, evidence quality was downgraded by 1 increment. Evidence was downgraded for indirectness where studies included a mixed population of people with and without known Barrett’s oesophagus. Evidence was also downgraded for indirectness where there was a lack of clarity around the quality of endoscopy as a reference standard, or where histology was used as a reference standard with white-light endoscopy results provided separately to those of the index test.

The majority of studies were of cross-sectional design, 5 studies being prospective and 3 studies being retrospective. There were also 5 randomised cross-over studies and 2 prospective randomised controlled trials included in the review.

It was noted in the literature high-resolution white light endoscopy is also referred to as high-definition white-light endoscopy. It has been extracted as reported in the studies, but the terms are used interchangeably within the evidence report with high-resolution white light endoscopy primarily used in the committee’s discussion of the evidence.

See also the study selection flow chart in Appendix C, sensitivity and specificity forest plots in Appendix E, and study evidence tables in Appendix D.

1.1.4.2. Excluded studies

See the excluded studies list in Appendix G.

1.1.5. Summary of studies included in the diagnostic evidence

Table 2

Summary of studies included in the evidence review.

See Appendix D for full evidence tables.

1.1.6. Summary of the diagnostic evidence

Clinical decision thresholds were set as sensitivity/specificity =0.9 and 0.8 above which a test would be recommended and 0.6 and 0.5 below which a test is of no clinical use.

Table 3

Clinical evidence summary: diagnostic test accuracy for chromoendoscopy.

Table 4

Clinical evidence summary: diagnostic test accuracy for endoscopic brushing.

Table 5

Clinical evidence summary: diagnostic test accuracy for artificial intelligence.

1.1.7. Economic evidence

1.1.7.1. Included studies

No health economic studies were included.

1.1.7.2. Excluded studies

No relevant health economic studies were excluded due to assessment of limited applicability or methodological limitations.

See also the health economic study selection flow chart in Appendix F.

1.1.8. Summary of included economic evidence

There was no economic evidence found.

1.1.9. Economic model

This area was given medium priority for new cost-effectiveness analysis.

1.1.10. Unit costs

Relevant unit costs are provided below to aid consideration of cost effectiveness.

Table

1.1.11. The committee’s discussion and interpretation of the evidence

1.1.11.1. The outcomes that matter most

The committee considered the diagnostic measures of sensitivity and specificity of the index tests for diagnosing dysplasia and early cancer. The sensitivity of tests was deemed the most important measure in this review because the committee agreed the most important outcome is to diagnose dysplasia which is associated with significant risk of progression to cancer. Thus, sensitivity was prioritised for decision making. Clinical decision thresholds were set by the committee as sensitivity/specificity =0.9 and 0.8 above which a test would be recommended and 0.6 and 0.5 below which a test is of no clinical use. The committee agreed that the default values of 0.9 and 0.8 that are widely used for decision making across clinical guidelines were also applicable to people with Barrett’s oesophagus and that these were high enough to ensure almost all cases of dysplasia are detected and that the majority of non-cases are correctly identified as such.

1.1.11.2. The quality of the evidence

Chromoendoscopy

12 studies were included for the diagnostic accuracy of chromoendoscopy. 3 studies (1 RCT and 2 observational prospective studies) were for confocal laser endomicroscopy including outcomes of high-grade neoplasia/dysplasia and carcinoma, intramucosal or oesophageal cancer. One of these studies also examined the diagnostic accuracy of high-resolution white-light endoscopy (with biopsy as the reference standard) separately. One multi-centre RCT looked at the diagnostic accuracy of high-resolution white light endoscopy combined with endoscope-based confocal laser endomicroscopy with targeted biopsies (HDWLE+CLE+TB) to detect neoplasia, reporting on the diagnostic accuracy high-resolution white light endoscopy alone with random biopsies (HDWLE+RB) separately.

Evidence on autofluorescence for detecting intestinal metaplasia with columnar and goblet cells, to detect low or high-grade dysplasia or cancer was available from 1 retrospective study. There was evidence from one RCT on the accuracy of autofluorescence imaging-guided probe-based confocal laser endomicroscopy and molecular biomarkers (3-biomarker panel) (AFI-guided pCLE) to detect dysplasia and high-grade dysplasia with the diagnostic accuracy of high-resolution white-light endoscopy given separately.

Evidence on methylene blue staining was available from 3 studies (1 retrospective, 1 prospective and 1 cross over RCT), and related to the detection of dysplasia or carcinoma, oesophageal cancer or intestinal metaplasia with columnar and goblet cells.

Evidence on narrow-band imaging was available from 4 studies (2 prospective, 1 RCT, 1 cross-over RCT) and related to the detection of high-grade dysplasia and oesophageal cancer or intramucosal cancer, low grade dysplasia or indefinite for dysplasia findings.

There was evidence from one cross-over RCT on endoscopic tri-modal imaging (incorporating high-resolution endoscopy, autofluorescence and narrow-band imaging) for the detection of high-grade dysplasia and early carcinoma with standard video endoscopy used as the reference standard and one cross-over RCT on acetic acid-targeted biopsies for detecting low-or high-grade dysplasia or cancer.

Evidence for sensitivity and specificity for different chromoendoscopy techniques was mostly of low and very low quality. Moderate quality evidence was available for specificity of probe-based confocal laser endomicroscopy in one study, both sensitivity and specificity of narrow-band imaging in one study, and sensitivity of acetic acid-targeted biopsies from one study. High quality evidence from one study was available for both sensitivity and specificity of narrow-band imaging, endoscopic-trimodal imaging, and specificity of acetic acid-targeted biopsies. Evidence was mostly downgraded for indirectness (that was due to the reference standard being histology or biopsy, with results for the protocol reference standard: white-light imaging given separately, or the reference standard being ‘standard endoscopy’ the quality of which was not specified or due to the population including people with oesophagitis in one study and diagnostic accuracy in one study not being limited to detection of dysplasia but results also including metaplasia) and imprecision in the effect measures. Evidence was occasionally downgraded for risk of bias (that was due to lack of blinding in the interpretation of each test or lack of details over the interpretation of the index test and reference standard results). Overall, evidence for chromoendoscopy techniques was derived from studies including 35 to 192 participants with results of 2 studies based on 874 to 1190 locations, with standard endoscopy or biopsy from the white light imaging reported as the reference standard.

Endoscopic brushing

Clinical evidence for the diagnostic accuracy of endoscopic brushing to detect Barrett’s metaplasia, indefinite for dysplasia, dysplasia and inadequate (no Barrett’s oesophagus) findings was available from one prospective study. The evidence was of low quality for sensitivity and very low quality for specificity and was downgraded due to risk of bias and indirectness, with specificity also downgraded for imprecision in the effect measure. The study included 151 people with forceps biopsy used as the reference standard.

Artificial intelligence

Clinical evidence for the diagnostic accuracy of artificial intelligence (AI) was available from 2 retrospective studies. One study looked at the diagnostic accuracy of convolutional neural networks to detect T1a or T1b neoplasia and the other study looked at Narrow-band imaging + AI and white-light imaging +AI to detect high-grade dysplasia, both using histology as the reference standard. The quality of the evidence for sensitivity and specificity ranged from very low to low for narrow-band imaging and white-light imaging combined with AI but was moderate for convolutional neural networks. Evidence was downgraded mostly for indirectness (due to AI combined with another technique for analysis of previously captured images, histology being the reference standard and results from white light endoscopy and narrow-band imaging given separately in one study and AI not being used immediately during endoscopy and the other study) and occasionally for risk of bias and imprecision based on the width of the confidence intervals around the effect estimate. The two studies included 100 and 116 people with results of the former study corresponding to 458 images obtained from those people.

1.1.11.3. Benefits and harms

Chromoendoscopy

The majority of the evidence for the diagnostic accuracy of different chromoendoscopy techniques suggested that both sensitivity and specificity did not meet the clinical threshold of 0.9 for sensitivity and 0.8 for specificity, that the committee had set above which a test would be recommended. Specificity evidence for probe-based confocal laser endomicroscopy did meet or exceeded the clinical threshold, but the committee noted that this was not the case for sensitivity which was prioritised for decision making. Sensitivity and Specificity of high-resolution white light endoscopy combined with confocal laser endomicroscopy with targeted biopsies to detect Barrett’s oesophagus neoplasia exceeded clinical thresholds, but the committee noted this was supported by one study and the evidence was of low quality. The committee also noted the limited availability of this equipment within endoscopy services and the need for longer procedural time, compared to standard endoscopy. It was also noted that where sensitivity and specificity of narrow-band imaging exceeded the clinical thresholds set for decision making, results were based on only one true positive case and the measure was imprecise. This was also the case for acetic acid-targeted biopsies where diagnostic accuracy results were based on two true positive and 172 negative cases resulting in imprecise estimates.

Sensitivity and specificity of chromoendoscopy with methylene blue staining for detecting Barrett’s oesophagus with oesophageal cancer in one study, also exceeded the clinical thresholds set by the committee. However, the committee noted evidence for sensitivity was of very low quality and was not supported by sensitivity or specificity evidence for methylene blue staining available from two other studies. The committee noted the diagnostic accuracy of methylene blue staining met clinical thresholds in relation to detecting oesophageal cancer whereas a lower sensitivity and specificity was shown in detecting dysplasia. The committee agreed this was in line with their clinical experience and emphasised that high and low-grade dysplasia are more difficult to detect compared to cancer, with dysplasia being flat which makes them easier to miss while cancer is often nodular. Hence image-enhanced techniques are required to detect lesions that may be missed by standard endoscopy.

Endoscopic brushing

Evidence for the diagnostic accuracy of endoscopic brushing showed sensitivity and specificity did not meet the clinical thresholds for decision making. The committee noted the evidence came from a single prospective study and was of low quality.

Artificial Intelligence

Evidence for the diagnostic accuracy of artificial intelligence (AI) showed high sensitivity and specificity for both narrow-band imaging combined with AI, and white-light imaging combined with AI, with both exceeding clinical thresholds of 0.9 and 0.8 respectively for detecting high grade dysplasia. The committee noted that sensitivity of white-light imaging when combined with AI was higher than that of the narrow-band imaging combined with AI (0.99 and 0.92 respectively) with the effect estimate for narrow-band imaging +AI being imprecise. The committee also noted that AI is currently not fully developed in the field of Barrett’s oesophagus as the algorithms have not been fully developed and are not available for wider use.

Overall

Overall, the committee agreed the current evidence was limited both in terms of quality with the majority of the evidence graded very low to low, and in quantity with a limited number of small studies available for each surveillance technique, the characteristics of which did not allow for a meta-analysis of findings. They acknowledged that on the basis of the evidence available, it was not possible to make a recommendation for any of the newer technologies such as AI, pCLE (which is currently not used outside a research context) and volumetric laser endomicroscopy or endoscopic brushing (both used in the USA but the UK) and further research is needed. Therefore, the committee made a research recommendation to assess the utility of image enhanced endoscopy in surveillance of Barrett’s oesophagus, including narrow band imaging, acetic acid and artificial intelligence.

No evidence was identified for trans-nasal endoscopy. The committee agreed, based on their clinical experience that trans-nasal endoscopy is unlikely to be better than standard endoscopy, given the lower quality of white light imaging and smaller size of biopsy forceps compared to conventional trans-oral endoscopy. They agreed not to make a recommendation for future research on trans-nasal endoscopy.

The committee decided to make a recommendation for surveillance of Barrett’s oesophagus using white light endoscopy with Seattle protocol biopsies based on their clinical experience and in recognition that this reflects the current standard of care for endoscopic surveillance for Barrett’s oesophagus. Seattle protocol biopsies entail 4 biopsies in different oesophageal quadrants taken every 2 centimetres within the Barrett’s oesophagus. Random biopsies are advised as dysplasia is often invisible on white light endoscopy.

See also evidence review C on endoscopic surveillance using white light endoscopy.

1.1.11.4. Cost effectiveness and resource use

There were no published economic evaluations found. In the absence of suitable clinical evidence, cost-effectiveness modelling was not feasible since a model will require good evidence of clinical effectiveness.

Standard white light endoscopy for surveillance of Barrett’s oesophagus is commonly available in the NHS. The committee’s decision to continue to recommend its use is unlikely to have an impact on resource use and ensures that patients continue to receive current standard of care. However, it should be noted that uptake of endoscopic surveillance in the NHS is currently sub-optimal and any changes in practice may result in subsequent changes in resource use.

The committee also made a research recommendation to assess the utility of image enhanced endoscopy for surveillance. If such techniques were to be recommended in future, it would be expected to cause a significant increase in resource use because of up-front staff training, an increase in costs associated with the new technologies and an increase in staff time for some procedures such as chromoendoscopy. However, the additional costs may be offset if there were evidence of increased diagnostic accuracy with the new technologies and a reduced need for biopsies.

1.1.12. Recommendations supported by this evidence review

This evidence review supports recommendations 1.3.1 to 1.3.5 and the research recommendation on endoscopic surveillance techniques.

1.1.13. References

1.: Anandasabapathy S, Sontag S, Graham DY, Frist S, Bratton J, Harpaz N et al Computer-assisted brush-biopsy analysis for the detection of dysplasia in a high-risk Barrett’s esophagus surveillance population. Digestive Diseases and Sciences. 2011; 56(3):761–766 [PubMed: 20978843]

2.: Bajbouj M, Vieth M, R?sch T, Miehlke S, Becker V, Anders M et al Probe-based confocal laser endomicroscopy compared with standard four-quadrant biopsy for evaluation of neoplasia in Barrett’s esophagus. Endoscopy. 2010; 42(6):435–440 [PubMed: 20506064]

3.: Canto MI, Anandasabapathy S, Brugge W, Falk GW, Dunbar KB, Zhang Z et al In vivo endomicroscopy improves detection of Barrett’s esophagus-related neoplasia: a multicenter international randomized controlled trial (with video). Gastrointestinal Endoscopy. 2014; 79(2):211–221 [PMC free article: PMC4668117] [PubMed: 24219822]

4.: Curvers WL, Alvarez Herrero L, Wallace MB, Wong Kee Song LM, Ragunath K, Wolfsen HC et al Endoscopic tri-modal imaging is more effective than standard endoscopy in identifying early-stage neoplasia in Barrett’s esophagus. Gastroenterology. 2010; 139(4):1106–1114 [PubMed: 20600033]

5.: Ebigbo A, Mendel R, Ruckert T, Schuster L, Probst A, Manzeneder J et al Endoscopic prediction of submucosal invasion in Barrett’s cancer with the use of artificial intelligence: A pilot study. Endoscopy. 2021; 53(9):878–883 [PubMed: 33197942]

6.: Egger K, Werner M, Meining A, Ott R, Allescher HD, Hofler H et al Biopsy surveillance is still necessary in patients with Barrett’s oesophagus despite new endoscopic imaging techniques. Gut. 2003; 52(1):18–23 [PMC free article: PMC1773515] [PubMed: 12477753]

7.: Hashimoto R, Requa J, Dao T, Ninh A, Tran E, Mai D et al Artificial intelligence using convolutional neural networks for real-time detection of early esophageal neoplasia in Barrett’s esophagus (with video). Gastrointestinal Endoscopy. 2020; 91(6):1264–1271 [PubMed: 31930967]

8.: Jayasekera C, Taylor AC F, Desmond PV, MacRae F, Williams R. Added value of narrow band imaging and confocal laser endomicroscopy in detecting Barretts esophagus neoplasia. Endoscopy. 2012; 44(12):1089–1095 [PubMed: 23188660]

9.: Longcroft-Wheaton G, Fogg C, Chedgy F, Kandiah K, Murray L, Dewey A et al A feasibility trial of acetic acid-targeted biopsies versus nontargeted quadrantic biopsies during Barrett’s surveillance: the ABBA trial. Endoscopy. 2020; 52(1):29–36 [PubMed: 31618768]

10.: National Institute for Health and Care Excellence. Developing NICE guidelines: the manual [updated January 2022]. London. National Institute for Health and Care Excellence, 2014. Available from: http://www.nice.org.uk/article/PMG20/chapter/1%20Introduction%20and%20overview

11.: Ormeci N, Savas B, Coban S, Palabiyikoglu M, Ensari A, Kuzu I et al The usefulness of chromoendoscopy with methylene blue in Barrett’s metaplasia and early esophageal carcinoma. Surgical Endoscopy. 2008; 22(3):693–700 [PubMed: 17704887]

12.: Pascarenco OD, Coros MF, Pascarenco G, Boeriu AM, Drasovean SC, Onisor DM et al A preliminary feasibility study: Narrow-band imaging targeted versus standard white light endoscopy non-targeted biopsies in a surveillance Barrett’s population. Digestive and Liver Disease. 2016; 48(9):1048–1053 [PubMed: 27246796]

13.: Ragunath K, Krasner N, Raman VS, Haqqani MT, Cheung WY. A randomized, prospective cross-over trial comparing methylene blue-directed biopsy and conventional random biopsy for detecting intestinal metaplasia and dysplasia in Barrett’s esophagus. Endoscopy. 2003; 35(12):998–1003 [PubMed: 14648410]

14.: Sharma P, Hawes RH, Bansal A, Gupta N, Curvers W, Rastogi A et al Standard endoscopy with random biopsies versus narrow band imaging targeted biopsies in Barrett’s oesophagus: A prospective, international, randomised controlled trial. Gut. 2013; 62(1):15–21 [PubMed: 22315471]

15.: Sharma P, Meining AR, Coron E, Lightdale CJ, Wolfsen HC, Bansal A et al Realtime increased detection of neoplastic tissue in Barrett’s esophagus with probe-based confocal laser endomicroscopy: Final results of an international multicenter, prospective, randomized, controlled trial. Gastrointestinal Endoscopy. 2011; 74(3):465–472 [PMC free article: PMC3629729] [PubMed: 21741642]

16.: Vithayathil M, Modolell I, Ortiz-Fernandez-Sordo J, Oukrif D, Pappas A, Januszewicz W et al Image-enhanced endoscopy and molecular biomarkers vs Seattle protocol to diagnose dysplasia in Barrett’s esophagus. Clinical Gastroenterology and Hepatology. 2022; 10.1016/j.cgh.2022.01.060 [PubMed: 35183768] [CrossRef]

Appendices

Appendix A. Review protocols

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Appendix B. Literature search strategies

The literature searches for this review are detailed below and complied with the methodology outlined in Developing NICE guidelines: the manual.¹⁰

For more information, please see the Methodology review published as part of the accompanying documents for this guideline.

Appendix E. Sensitivity and specificity forest plots

E.1. Chromoendoscopy

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E.2. Endoscopic brushing

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E.3. Artificial intelligence

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Appendix F. Economic evidence study selection

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Appendix G. Excluded studies

Clinical studies

Table 8

Studies excluded from the clinical review.

Health Economic studies

Published health economic studies that met the inclusion criteria (relevant population, comparators, economic study design, published 2006 or later and not from non-OECD country or USA) but that were excluded following appraisal of applicability and methodological quality are listed below. See the health economic protocol for more details.

None.

Appendix H. Research recommendations

Endoscopic surveillance

What is the diagnostic accuracy of different endoscopic surveillance techniques including high resolution endoscopy and chromoendoscopy for use in adults?

Why this is important

Chromoendoscopy, electronic imaging and more recently artificial intelligence have all shown considerable promise in enriched patient populations but their utility in a surveillance population is unclear. In order for image enhanced endoscopy based surveillance protocols to be implemented robust data in a low risk Barrett’s surveillance population (i.e. patients who have no history of previous dysplasia or cancer) is needed from high quality fully powered studies.

Large scale studies in patients undergoing endoscopic surveillance are therefore recommended for assessing clinical and cost effectiveness of image enhanced endoscopy in surveillance of Barrett’s oesophagus. Narrow band imaging, acetic acid and artificial intelligence are considered as most appropriate for clinical trials.

Rationale for research recommendation

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Modified PICO table

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Final version

Evidence review underpinning recommendations 1.3.1 to 1.3.5 and a research recommendation in the NICE guideline

Disclaimer: The recommendations in this guideline represent the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, professionals are expected to take this guideline fully into account, alongside the individual needs, preferences and values of their patients or service users. The recommendations in this guideline are not mandatory and the guideline does not override the responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or their carer or guardian.

Local commissioners and/or providers have a responsibility to enable the guideline to be applied when individual health professionals and their patients or service users wish to use it. They should do so in the context of local and national priorities for funding and developing services, and in light of their duties to have due regard to the need to eliminate unlawful discrimination, to advance equality of opportunity and to reduce health inequalities. Nothing in this guideline should be interpreted in a way that would be inconsistent with compliance with those duties.

NICE guidelines cover health and care in England. Decisions on how they apply in other UK countries are made by ministers in the Welsh Government, Scottish Government, and Northern Ireland Executive. All NICE guidance is subject to regular review and may be updated or withdrawn.

Bookshelf ID: NBK595309PMID: 37792985

Table 1PICO characteristics of review question

Population	Inclusion: Adults, 18 years and over, with Barrett’s Oesophagus (with or without dysplasia) Exclusion: Adults with Barrett’s Oesophagus that does not fit within the definition
Target condition	Barrett’s Oesophagus
Index tests	Trans-nasal endoscopy Chromoendoscopy (e.g., narrow band imaging, blue laser imaging, confocal endomicroscopy, volumetric laser endomicroscopy, acetic acid) Endoscopic brushing (wide area transepithelial sampling wats3D) Artificial Intelligence (AI) Strata: Type of endoscopic surveillance (transnasal, chromoendoscopy, enodscopic brushing, AI)
Reference standard	High resolution white light endoscopy (with Seattle protocol biopsies)
Outcome and statistical measures	Detection of progression of dysplasia Sensitivity Specificity Data to calculate 2×2 tables to calculate sensitivity and specificity (number of true positives, true negatives, false positives and false negatives).
Study design	Observational studies: Cross-sectional studies Prospective / Retrospective diagnostic studies Systematic Reviews of observational studies Any study containing a diagnostic accuracy data or analysis

Table 2Summary of studies included in the evidence review

Study	Population	Target condition	Index test	Reference standard	Comments
*Chromoendoscopy*
Bajbouj 2010 ²	Participants aged 18 – 80 years; Barrett’s length at least COM1 according to Prague classification; in the case of suspected intraepithelial neoplastic changes, lesion <1cm; acid-suppressive therapy at least at the standard dose for a minimum of 4 weeks (n=68) Age, mean (SD): 60 ± 12 years Germany	Barrett’s Oesophagus: high grade intraepithelial neoplasia / carcinoma	Probe based confocal laser endomicroscopy	Standard endoscopy	Diagnostic data reported per biopsy and per patient 2×2 data not reported
Canto 2014³	Barrett’s oesophagus patients undergoing routine surveillance or referred for confirmation of diagnosis and/or endoscopic therapy (n=192) Median age (range): high-definition white-light endoscopy and random biopsy group: 62 (26 to 79); high-definition white-light endoscopy followed by laser endomicroscopy and targeted biopsy group: 62 (32 to 82) USA	Barrett’s oesophagus confocal neoplasia	High-definition white light endoscopy alone with random biopsies (HDWLE+RB) High-definition white light endoscopy + endoscope-based confocal laser endomicroscopy (CLE) with targeted biopsies (HDWLE+CLE+TB)	Blinded expert pathologic diagnosis	Multi-centre RCT 2×2 data not reported
Curvers 2010 ⁴	Patients with Barrett’s oesophagus referred to 5 participating centres for workup of endoscopically inconspicuous high-grade dysplasia/ early carcinoma (HGD/Ca) (n=87) Age, mean (SD): 68 (9) Netherlands & USA	Barrett’s oesophagus with high grade dysplasia and early carcinoma	Endoscopic trimodal imaging (incorporating high-resolution endoscopy, autofluorescence and narrow-band imaging)	Standard video endoscopy	Randomised cross-over multicentre study 2×2 data calculated
Egger 2003⁶	Participants undergoing routine surveillance for non dysplastic, dysplastic or first time in surveillance for confirmed Barrett’s Oesophagus without (n=18) or with (n=8) only low grade dysplasia Age, mean (range): 64.8 years; range 29–78 Germany	Barrett’s Oesophagus with intestinal metaplasia with columnar and goblet cells vs low or high grade dysplasia, cancer	Autofluorescence Methylene blue staining	Standard endoscopy	Diagnostic data given per biopsy and per patient 2×2 data not reported Indirectness: sensitivity and specificity were not reported separately for dysplasia or cancer but also include metaplasia findings.
Jayasekera 2012 ⁸	Patients referred for endoscopic evaluation and treatment of dysplastic Barrett’s oesophagus, which had been previously diagnosed by their referring physician (n=50) Age, median (range): 66 (41–86) years Australia	Barrett’s oesophagus with high grade dysplasia and intramucosal cancer.	Narrow-band imaging Confocal laser endomicroscopy High definition white light endoscopy	Histology (Seattle protocol)	Study aim: to assess 3 consecutive imaging modalities with histological assessment (standard Seattle protocol biopsies) as the reference standard. 2×2 data calculated Indirectness: Serious indirectness as results for white light endoscopy are given separately with biopsy as the reference standard
Longcroft-Wheaton ⁹	People with biopsy-proven Barrett’s oesophagus, no history or prior dysplasia or cancer, positive for intestinal metaplasia Age, mean (SD): 66 (11.1) UK	Barrett’s oesophagus with neoplasia (high grade dysplasia, low grade dysplasia, cancer)	Acetic acid-targeted biopsies (Portsmouth protocol)	Seattle protocol-guided nontargeted biopsies.	Pilot multi-centre randomised cross-over trial 2×2 data calculated
Ormeci 2008 ¹¹	Patients older than 18 years with an indication for esophagogastroduodenoscopy were selected for this study (n=109) Age, mean (SD): 62.32 (10.61 years); range, 33–82 years Turkey	Barrett’s Oesophagus with dysplasia or cancer	Chromoendoscopy with methylene blue	Standard endoscopy	Histopathologic diagnosis was accepted as the gold standard, and conventional endoscopic or chromoendoscopic diagnosis was compared with the histopathologic diagnosis. Results from chromoendoscopy and standard/conventional endoscopy reported separately. 2×2 data not reported
Pascarenco 2016 ¹²	Patients over 18 with endoscopic confirmation of Barrett’s Oesophagus (n=84) Age, mean (range): 57.4 (26–84) Romania	Barrett’s oesophagus with low grade dysplasia or indefinite for dysplasia	Narrow-band imaging	White light imaging	2×2 data calculated
Ragunath 2003¹³	Patients with endoscopic and histological diagnosis of Barrett’s oesophagus segments of 3cm or more in length, adults patients of any sex attending for endoscopy, including newly diagnosed patients as well as those undergoing surveillance endoscopy for Barrett’s Oesophagus, and patients known to have dysplasia without mucosal abnormalities who were receiving follow up endoscopies (n=57) Age: not reported UK	Barrett’s Oesophagus with dysplasia or carcinoma	Methylene blue	Standard endoscopy	2×2 data not reported
Sharma 2011 ¹⁵	Consecutive patients undergoing BE surveillance and/or referred for BE-associated neoplasia (HGD/oesophageal carcinoma) evaluation and treatment were prospectively enrolled in this trial at 5 hospitals (n=101) Age, mean (range): 65.1 years (27–90 years) France, Germany & USA	Barrett’s Oesophagus: high grade dysplasia / oesophageal cancer	Narrow-band imaging Probe-based confocal laser endomicroscopy	Histology	Diagnostic data reported per location 2×2 data calculated Indirectness: the paper measures diagnostic accuracy of the visual findings from each HD-WLE, NBI, pCLE with reference to the full histological findings. i.e. reference standard was histology derived from biopsies from each procedure rather than histology from biopsies from the HD-WLE
Sharma 2013¹⁴	Patients undergoing screening or surveillance for Barrett’s oesophagus at three tertiary referral centres. Age, mean (range): 61 (38–85) years USA, Netherlands	Barrett’s oesophagus with neoplasia (high grade dysplasia, oesophageal adenocarcinoma)	Narrow-band imaging	White-light endoscopy	Multi-centre randomised crossover trial 2×2 data calculated
Vithayathil 2022 ¹⁶	Non-dysplastic Barrett’s oesophagus patients (n=134) Age, median (range): 67.3 (38.0 to 89.0) years UK	Dysplasia (dysplasia and high-grade dysplasia)	Autofluorescence imaging- guided probe-based confocal laser endomicroscopy and molecular biomarkers (3-biomarker panel) (AFI-guided pCLE) High-resolution white-light endoscopy with Seattle protocol biopsies	Histology	Cross-over RCT Biomarkers: p53 and cyclin A by immunohistochemistry; aneuploidy by image cytometry)
*Endoscopic Brushing*
Anandasabapathy 2011 ¹	Subjects with a known prior history (recent or remote) of Barrett’s oesophagus with dysplasia/neoplasia (indefinite for-dysplasia (IND), low-grade (LGD), high-grade dysplasia (HGD) or intramucosal adenocarcinoma (IMCA) and no grossly evident lesion (n=181) Age, mean (range): 65 (46 – 87) USA	Barrett’s Oesophagus: Barrett’s metaplasia (IM), indefinite for dysplasia (IND), dysplasia (LGD/HGD/CA), and inadequate (no Barrett’s oesophagus)	Brush biopsy	Forceps biopsy (refers to Seattle protocol biopsy)	Study does not mention the type or methodology of endoscopic examination for biopsies and only notes the comparison of brush versus forceps. 2×2 data available
*Artificial Intelligence*
Ebigbo 2020 ⁵	Endoscopic, high resolution, white light images of T1a and T1b Barett’s Cancer were collected retrospectively in three tertiary care centres in Germany (n=230 images) Age not reported Germany	Barrett’s Oesophagus with T1a or T1b neoplasia	Convolutional neural networks	Histopathology (from white light imaging samples)	2×2 data not reported
Hashimoto 2020 ⁷	Images from participants with histologically proven dysplasia (high grade dysplasia and T1 adenocarcinoma) in Barrett’s (n=100 patients; 1832 images) Age: not reported USA	Barrett’s Oesophagus with high grade dysplasia	Narrow-band imaging + AI	White light imaging	Results for: narrow-band imaging +AI and white light imaging + AI, are provided separately with histology used as the reference standard Diagnostic data given per image taken 2×2 data calculated

Table 3Clinical evidence summary: diagnostic test accuracy for chromoendoscopy

Index test	Number of patients (studies)	Risk of bias	Inconsistency	Indirectness	Imprecision	Effect size (95%CI)	Quality
Probe based confocal laser endomicroscopy to detect Barrett’s Oesophagus: high grade intraepithelial neoplasia / carcinoma
Probe based confocal laser endomicroscopy (reference standard: standard endoscopy)	68 (1)	Very serious¹	Not serious	Not serious	Serious ²	Sensitivity=0.64 (0.31–0.89)	VERY LOW
	68 (1)	Very serious¹	Not serious	Not serious	Not serious	Specificity=0.95 (0.85–0.99)	LOW
Probe-based confocal laser endomicroscopy to detect Barrett’s Oesophagus: high grade dysplasia / oesophageal cancer
Probe-based confocal laser endomicroscopy (reference standard: histology)	101 patients; results based on 874 locations (1)	Not serious	Not serious	Serious³	Serious²	Sensitivity= 0.63 (0.53–0.71)	LOW
	101 patients; results based on 874 locations (1)	Not serious	Not serious	Serious³	Not serious	Specificity= 0.91 (0.89–0.93)	MODERATE
Confocal laser endomicroscopy to detect Barrett’s oesophagus with high grade dysplasia and intramucosal cancer
Confocal laser endomicroscopy (reference standard: biopsy)	50; results based on 1117	Very serious¹	Not serious	Serious³	Not serious	Sensitivity= 0.76 (0.64–0.85)	VERY LOW
Confocal laser endomicroscopy (reference standard: biopsy)	50; results based on 1117	Very serious¹	Not serious locations (1)	Serious³	Serious²	Specificity= 0.80 (0.78–0.83)	VERY LOW
High-definition white light endoscopy to detect Barrett’s oesophagus with high grade dysplasia and intramucosal cancer
High-definition white light endoscopy (reference standard: biopsy)	50; results based on 1190 locations (1)	Very serious¹	Not serious	Serious³	Not serious	Sensitivity= 0.82 (0.73–0.90)	VERY LOW
	50; results based on 1190 locations (1)	Very serious¹	Not serious	Serious³	Not serious	Specificity= 0.83 (0.81–0.85)	VERY LOW
High-definition white light endoscopy combined with confocal laser endomicroscopy with targeted biopsies to detect Barrett’s oesophagus neoplasia
HDWLE+CLE+TB (reference standard: blinded expert pathology)	192 (1)	Not serious	Not serious	Serious³	Cannot be assessed⁴	Sensitivity= 0.95	LOW
HDWLE+CLE+TB (reference standard: blinded expert pathology)	192 (1)	Not serious	Not serious	Serious³	Cannot be assessed⁴	Specificity= 0.92	LOW
High-definition white light endoscopy with random biopsies to detect Barrett’s oesophagus neoplasia
HDWLE+RB (reference standard: blinded expert pathology)	192 (1)	Not serious	Not serious	Serious³	Cannot be assessed⁴	Sensitivity: 0.40	LOW
HDWLE+RB (reference standard: blinded expert pathology)	192 (1)	Not serious	Not serious	Serious³	Cannot be assessed⁴	Specificity= 0.98	LOW
Autofluorescence-guided probe-based confocal laser endomicroscopy (with targeted biopsies) to detect Barrett’s oesophagus with dysplasia
Afi-guided pCLE (reference standard: histology)	35 (1)	Serious¹	Not serious	Serious³	Serious²	Sensitivity= 0.74 (0.57–0.88)	VERY LOW
Afi-guided pCLE (reference standard: histology)	35 (1)	Serious¹	Not serious	Serious³	Cannot be assessed⁴	Specificity= 0.67	VERY LOW
Autofluorescence-guided probe-based confocal laser endomicroscopy (with targeted biopsies) to detect high-grade dysplasia
Afi-guided pCLE (reference standard: histology)	17 (1)	Serious¹	Not serious	Serious³	Serious²	Sensitivity= 0.77 (0.50–0.93)	VERY LOW
Afi-guided pCLE (reference standard: histology)	17 (1)	Serious¹	Not serious	Serious³	Cannot be assessed⁴	Specificity= 0.60	VERY LOW
High resolution white light endoscopy to detect Barrett’s oesophagus with dysplasia
High-resolution white light endoscopy (reference standard: histology)	35 (1)	Serious¹	Not serious	Serious³	Serious²	Sensitivity= 0.80 (63.1–91.6)	VERY LOW
	35 (1)	n/a	n/a	n/a	n/a	Specificity: not reported	n/a
High resolution white light endoscopy to detect high-grade dysplasia
High-resolution white light endoscopy (reference standard: histology)	17 (1)	Serious¹	Not serious	Serious³	Serious²	Sensitivity= 0.77 (0.50–0.93)	VERY LOW
	17 (1)	n/a	n/a	n/a	n/a	Specificity: not reported	n/a
Autofluorescence to detect Barrett’s Oesophagus with intestinal metaplasia with columnar and goblet cells, low or high grade dysplasia, cancer
Autofluorescence (reference standard: standard endoscopy)	35 (1)	Serious¹	Not serious	serious³	Cannot be assessed⁴	Sensitivity = 0.59	VERY LOW
Autofluorescence (reference standard: standard endoscopy)	35 (1)	Serious¹	Not serious	serious³	Cannot be assessed⁴	Specificity= 0.78	VERY LOW
Methylene blue staining to detect Barrett’s Oesophagus with intestinal metaplasia with columnar and goblet cells, low or high grade dysplasia, cancer
Methylene blue staining (reference standard: standard endoscopy)	35 (1)	Serious¹	Not serious	Not serious	Cannot be assessed⁴	Sensitivity = 0.71	LOW
	35 (1)	Serious¹	Not serious	Not serious	Cannot be assessed⁴	Specificity= 0.50	LOW
Chromoendoscopy with methylene blue to detect Barrett’s Oesophagus with dysplasia
Chromoendoscopy with methylene blue	109 (1)	Serious¹	Not serious	Serious³	Serious²	Sensitivity= 0.68 (0.46–0.85)	VERY LOW
Chromoendoscopy with methylene blue	109 (1)	Serious¹	Not serious	Serious³	Serious²	Specificity= 0.77(0.67–0.84)	VERY LOW
Chromoendoscopy with methylene blue to detect Barrett’s Oesophagus with oesophageal cancer
Conventional endoscopy	109 (1)	Serious¹	Not serious	Serious³	Serious²	Sensitivity= 0.95 (0.75–0.99)	VERY LOW
Conventional endoscopy		Serious¹	Not serious	Serious³	Not serious	Specificity= 0.99 (0.94–0.98)	LOW
Chromoendoscopy with methylene blue		Serious¹	Not serious	Serious³	Serious²	Sensitivity= 0.95 (0.75–0.99)	VERY LOW
Chromoendoscopy with methylene blue		Serious¹	Not serious	Serious³	Not serious	Specificity= 1.00 (0.94–0.98)	LOW
Methylene blue directed imaging and biopsy to detect Barrett’s Oesophagus with dysplasia or carcinoma
Methylane blue (reference standard: standard endoscopy)	57 (1); per biopsy analysis	Serious¹	Not serious	Serious³	Serious²	Sensitivity= 0.49 (0.38–0.61)	VERY LOW
Methylane blue (reference standard: standard endoscopy)	57 (1); per biopsy analysis	Serious¹	Not serious	Serious³	Serious²	Specificity= 0.85 (0.82–0.88)	VERY LOW
Narrow-band imaging to detect Barrett’s Oesophagus: high grade dysplasia / oesophageal cancer
Narrow-band imaging (reference standard: HD white light endoscopy)	101 patients; results based on 874 locations (1)	Not serious	Not serious	Serious³	Not serious	Sensitivity= 0.42 (0.33–0.51)	HIGH
	101 patients; results based on 874 locations (1)	Not serious	Not serious	Serious³	Not serious	Specificity= 0.89 (0.87–0.91)	HIGH
Narrow-band imaging to detect Barrett’s Oesophagus: high grade dysplasia and intramucosal cancer
Narrow-band imaging (reference standard: biopsy)	50; results based on 1190 biopsies (1)	Very serious¹	Not serious	Serious³	Serious²	Sensitivity= 0.89 (0.81 – 0.95)	VERY LOW
Narrow-band imaging (reference standard: biopsy)	50; results based on 1190 biopsies (1)	Very serious¹	Not serious	Serious³	Serious²	Specificity= 0.81 (0.79 – 0.83)	VERY LOW
Narrow-band imaging to detect Barrett’s Oesophagus: low grade dysplasia or indefinite for dysplasia
Narrow-band imaging (reference standard: white light imaging)	84 (1)	Not serious	Not serious	Not serious	Very serious²	Sensitivity= 1.00 (0.03 – 1.00)	MODERATE
	84 (1)	Not serious	Not serious	Not serious	Serious²	Specificity=0.89 (0.80–0.95)	MODERATE
Endoscopic tri-modal imaging to detect Barrett’s oesophagus with high grade dysplasia/ early carcinoma
Endoscopic trimodal imaging (reference standard: standard video endoscopy)	87 (1)	Not serious	Not serious	Not serious	Not serious	Sensitivity= 0.78 (0.62–0.89)	HIGH
	87 (1)	Not serious	Not serious	Not serious	Not serious	Specificity= 0.68 (0.53–0.81)	HIGH
Acetic acid-targeted biopsies (Portsmouth protocol) to detect Barrett’s oesophagus with neoplasia (high-grade dysplasia, cancer)
Acetic acid-targeted biopsies (Portsmouth protocol) (reference standard: Seattle protocol-guided nontargeted biopsies)	174 (1)	Not serious	Not serious	Not serious	Very serious²	Sensitivity= 1.00(0.16–1.00)	MODERATE
	174 (1)	Not serious	Not serious	Not serious	Not serious	Specificity= 1.00 (0.98–1.00)	HIGH

1: Risk of bias was assessed using the QUADAS-2 checklist. The evidence was downgraded by 1 increment if the studies were rated at high risk of bias and downgraded by 2 increments if the studies were rated at very high risk of bias.

2: Imprecision was assessed based on inspection of the confidence intervals. For sensitivity, two clinical decision thresholds were determined at the value above which a test would be recommended (90%), and a second below which a test would be considered of no clinical use (60%). For specificity, two clinical decision thresholds were determined at the value above which a test would be recommended (80%), and a second below which a test would be considered of no clinical use (50%). The evidence was downgraded by 1 increment when the range of the confidence interval around the point estimate crossed one threshold and downgraded by 2 increments when the range covered two thresholds.

3: Evidence was downgraded by 1 increment if the study was rated as having serious indirectness and downgraded by 2 increments if the study was rated as having very serious indirectness.

4: Where the study does not report confidence intervals or the data to calculate 2×2 tables imprecision cannot be assessed. Where this is the case evidence quality was downgraded by 1 increment.

Table 4Clinical evidence summary: diagnostic test accuracy for endoscopic brushing

Index test	Number of patients (studies)	Risk of bias	Inconsistency	Indirectness	Imprecision	Effect size (95%CI)	Quality
Brush biopsy to detect Barrett’s Oesophagus: Barrett’s metaplasia, indefinite for dysplasia, dysplasia and inadequate (no BE)
Brush biopsy (reference standard: forceps biopsy)	151 (1)	Serious¹	Not serious	Serious²	Not serious	Sensitivity= 0.81 (0.73–0.87)	LOW
Brush biopsy (reference standard: forceps biopsy)	151 (1)	Serious¹	Not serious	Serious²	Serious ³	Specificity=0.48 (0.30–0.67)	VERY LOW

1: Risk of bias was assessed using the QUADAS-2 checklist. The evidence was downgraded by 1 increment if the studies were rated at high risk of bias and downgraded by 2 increments if the studies were rated at very high risk of bias.

2: Evidence was downgraded by 1 increment if the majority of studies were rated as having serious indirectness.

3: Imprecision was assessed based on inspection of the confidence intervals. For sensitivity, two clinical decision thresholds were determined at the value above which a test would be recommended (90%), and a second below which a test would be considered of no clinical use (60%). For specificity, two clinical decision thresholds were determined at the value above which a test would be recommended (80%), and a second below which a test would be considered of no clinical use (50%). The evidence was downgraded by 1 increment when the range of the confidence interval around the point estimate crossed one threshold and downgraded by 2 increments when the range covered two thresholds.

Table 5Clinical evidence summary: diagnostic test accuracy for artificial intelligence

Index test	Number of patients (studies)	Risk of bias	Inconsistency	Indirectness	Imprecision	Effect size (95%CI)	Quality
Convolutional neural networks to detect Barrett’s Oesophagus with T1a or T1b neoplasia
Convolutional neural networks (reference standard: histopathology (from white light imaging samples)	116; 230 images (1)	Not Serious	Not serious	Serious²	Not serious	Sensitivity= 0.77 (0.75 – 0.78)	MODERATE
	116; 230 images (1)	Not Serious	Not serious	Serious²	Not serious	Specificity= 0.64 (0.62 – 0.66)	MODERATE
Narrow-band imaging + AI to detect Barrett’s Oesophagus with high grade dysplasia
Narrow-band imaging +AI (reference standard: histology)	100 patients;45 8 images (1)	Serious¹	Not serious	Serious²	Serious³	Sensitivity= 0.92 (0.84–0.97)	VERY LOW
Narrow-band imaging +AI (reference standard: histology)	100 patients;45 8 images (1)	Serious¹	Not serious	Serious²	Not serious	Specificity= 0.99 (0.96–1.00)	LOW
White light imaging +AI to detect Barrett’s Oesophagus with high grade dysplasia
White light imaging +AI (reference standard: histology)	100 patients; 458images (1)	Serious¹	Not serious	Serious²	Not serious	Sensitivity= 0.99 (0.95–1.00)	LOW
White light imaging +AI (reference standard: histology)	100 patients; 458images (1)	Serious¹	Not serious	Serious²	Serious³	Specificity= 0.89 (0.81–0.94)	VERY LOW

1: Risk of bias was assessed using the QUADAS-2 checklist. The evidence was downgraded by 1 increment if the studies were rated at high risk of bias and downgraded by 2 increments if the studies were rated at very high risk of bias.

2: Evidence was downgraded by 1 increment if the study was rated as having serious indirectness.

3: Imprecision was assessed based on inspection of the confidence intervals. For sensitivity, two clinical decision thresholds were determined at the value above which a test would be recommended (90%), and a second below which a test would be considered of no clinical use (60%). For specificity, two clinical decision thresholds were determined at the value above which a test would be recommended (80%), and a second below which a test would be considered of no clinical use (50%). The evidence was downgraded by 1 increment when the range of the confidence interval around the point estimate crossed one threshold and downgraded by 2 increments when the range covered two thresholds.

Resource	Unit costs	Source
diagnostic endoscopic upper gastrointestinal tract procedure with biopsy, (FE21Z)	£554	National Schedule of NHS Costs. 2019/20

Table 8Studies excluded from the clinical review

Study	Exclusion reason
Admad, N. Z. and Ahmed, A. (2010) A meta-analysis of randomized controlled trials comparing methylene blue-directed biopsies with random biopsies in the surveillance of Barrett’s esophagus. Esophagus 7(4): 207–213	- Study design not relevant to this review protocol
Aedo, M. R., Zavala-Gonzalez, M. A., Meixueiro-Daza, A. et al (2014) Accuracy of transnasal endoscopy with a disposable esophagoscope compared to conventional endoscopy. World Journal of Gastrointestinal Endoscopy 6(4): 128–36 [PMC free article: PMC3985153] [PubMed: 24748920]	- Population not relevant to this review protocol
Alves, J. R., Graffunder, F. P., Rech, J. V. T. et al (2020) Diagnosis, Treatment and Follow-up of Barrett’s Esophagus: A Systematic Review. Arquivos de Gastroenterologia 57(3): 289–295 [PubMed: 33027480]	- Data not reported in an extractable format or a format that can be analysed
Anagnostopoulos, G. K., Yao, K., Kaye, P. et al (2007) Novel endoscopic observation in Barrett’s oesophagus using high resolution magnification endoscopy and narrow band imaging. Alimentary Pharmacology & Therapeutics 26(3): 501–7 [PubMed: 17635385]	- Study does not contain an intervention relevant to this review protocol non comparative use of NBI in addition to standard endoscopy to calculate its diagnostic accuracy. Amsterdam protocol for biopsies.
Ang, T. L., Pittayanon, R., Lau, J. Y. et al (2015) A multicenter randomized comparison between high-definition white light endoscopy and narrow band imaging for detection of gastric lesions. European Journal of Gastroenterology & Hepatology 27(12): 1473–1478 [PubMed: 26426836]	- Population not relevant to this review protocol participants not with Barrett’s Oesophagus, but for general investigation
Areia, M., Amaro, P., Dinis-Ribeiro, M. et al (2008) External validation of a classification for methylene blue magnification chromoendoscopy in premalignant gastric lesions. Gastrointestinal Endoscopy 67(7): 1011–8 [PubMed: 18178207]	- Population not relevant to this review protocol magnification chromoendoscopy for gastric atrophy and dysplasia
Arribas, J., Antonelli, G., Frazzoni, L. et al (2020) Standalone performance of artificial intelligence for upper GI neoplasia: a meta-analysis. Gut 70: 1458–1468 [PubMed: 33127833]	- Systematic review used as source of primary studies
Bang, C. S.; Lee, J. J.; Baik, G. H. (2021) Computer-aided diagnosis of esophageal cancer and neoplasms in endoscopic images: a systematic review and meta-analysis of diagnostic test accuracy. Gastrointestinal Endoscopy 93(5): 1006–1015.e13 [PubMed: 33290771]	- Systematic review used as source of primary studies
Bhardwaj, A., Hollenbeak, C. S., Pooran, N. et al (2009) A meta-analysis of the diagnostic accuracy of esophageal capsule endoscopy for Barrett’s esophagus in patients with gastroesophageal reflux disease. American Journal of Gastroenterology 104(6): 1533–9 [PubMed: 19491867]	- Systematic review used as source of primary studies
Bhatti, K. M., Khanzada, Z. S., Kuzman, M. et al (2021) Diagnostic Performance of Artificial Intelligence-Based Models for the Detection of Early Esophageal Cancers in Barret’s Esophagus: A Meta-Analysis of Patient-Based Studies. Cureus 13(6): e15447 [PMC free article: PMC8255083] [PubMed: 34258114]	- Systematic review used as source of primary studies
Borovicka, J., Fischer, J., Neuweiler, J. et al (2006) Autofluorescence endoscopy in surveillance of Barrett’s esophagus: a multicenter randomized trial on diagnostic efficacy. Endoscopy 38(9): 867–872 [PubMed: 16981102]	- Study design not relevant to this review protocol Crossover RCT with some diagnostic data, however incomplete and unclear of analysis
Bratlie, S. O., Johnsson, E., Jonsson, C. et al (2015) Multiple-Band Imaging Provides Better Value Than White-light Endoscopy in Detection of Dysplasia in Patients With Barrett’s Esophagus. Clinical Gastroenterology and Hepatology 13(6): 1068–1074.e2 [PubMed: 25499989]	- Data not reported in an extractable format or a format that can be analysed relevant comparison, data incomplete with only sensitivity narratively reported. Data in table also incomplete
Camus, M., Coriat, R., Leblanc, S. et al (2012) Helpfulness of the combination of acetic acid and FICE in the detection of Barrett’s epithelium and Barrett’s associated neoplasias. World Journal of Gastroenterology 18(16): 1921–5 [PMC free article: PMC3337567] [PubMed: 22563172]	- Data not reported in an extractable format or a format that can be analysed Data reported narratively, table with analysis does not correlate and cannot calculate diagnostic accuracy from this data
Canto, M. I., Setrakian, S., Willis, J. et al (2000) Methylene blue-directed biopsies improve detection of intestinal metaplasia and dysplasia in Barrett’s esophagus. Gastrointestinal Endoscopy 51(5): 560–8 [PubMed: 10805842]	- Study design not relevant to this review protocol cost and correlation of biopsies with standard endoscopy versus endoscopy + staining to diagnosis. Cannot use data for diagnostic accuracy analysis.
Chai, T. H., Jin, X. F., Li, S. H. et al (2014) A tandem trial of HD-NBI versus HD-WL to compare neoplasia miss rates in esophageal squamous cell carcinoma. Hepato-Gastroenterology 61(129): 120–124 [PubMed: 24895806]	- Population not relevant to this review protocol Squamous cell carcinoma and no relevant outcomes
Chandan, S., Mashiana, H. S., Dhaliwal, A. J. et al (2020) CLINICAL APPLICABILITY OF WIDE AREA TRANSEPITHELIAL SAMPLING (WATS3D) IN SCREENING & SURVEILLANCE OF BARRETT’S ESOPHAGUS - A SYSTEMATIC REVIEW & SENSITIVITY META-ANALYSIS. Gastrointest. Endosc. 91(6): AB395-AB396	- Conference abstract
Chedgy, F., Fogg, C., Kandiah, K. et al (2018) Acetic acid-guided biopsies in Barrett’s surveillance for neoplasia detection versus non-targeted biopsies (Seattle protocol): A feasibility study for a randomized tandem endoscopy trial. The ABBA study. Endoscopy International Open 6(1): E43-E50 [PMC free article: PMC5766339] [PubMed: 29340297]	- Study design not relevant to this review protocol study protocol only
Chen, B. L., Xing, X. B., Wang, J. H. et al (2014) Improved biopsy accuracy in Barrett’s esophagus with a transparent cap. World Journal of Gastroenterology 20(16): 4718–4722 [PMC free article: PMC4000508] [PubMed: 24782624]	- Study does not contain an intervention relevant to this review protocol the addition of a cap compared to no cap for endoscopy.
Chen, H., Liu, Y., Lu, Y. et al (2018) Ability of blue laser imaging with magnifying endoscopy for the diagnosis of gastric intestinal metaplasia. Lasers in Medical Science 33(8): 1757–1762 [PubMed: 29777405]	- Population not relevant to this review protocol participants under investigation for gastric cancer not oesophageal cancer
Chen, H., Wu, X., Liu, Y. et al (2019) Blue laser imaging with acetic acid enhancement improved the detection rate of gastric intestinal metaplasia. Lasers in Medical Science 34(3): 555–559 [PubMed: 30191343]	- Population not relevant to this review protocol participants under investigation for gastric / intestinal metaplasia
Chen, Q., Cheng, H. H., Deng, S. et al (2018) Diagnosis of Superficial Gastric Lesions Together with Six Gastric Lymphoma Cases via Probe-Based Confocal Laser Endomicroscopy: A Retrospective Observational Study. Gastroenterology research & practice 2018: 5073182 [PMC free article: PMC6020488] [PubMed: 30008745]	- Population not relevant to this review protocol Participants under investigation for or with gastric lesions
Chen, J., Yang, J., Chang, T. S. et al (2022) Detection of Barrett’s Neoplasia with Near-infrared Fluorescent Heterodimeric Peptide. Endoscopy 17: 17 [PMC free article: PMC9718637] [PubMed: 35299273]	- Comparator in study does not match that specified in this review protocol unclear if white light imaging was used as a reference standard for comparison
Chung, C. S., Liao, L. J., Lo, W. C. et al (2013) Risk factors for second primary neoplasia of esophagus in newly diagnosed head and neck cancer patients: a case-control study. BMC Gastroenterology 13: 154 [PMC free article: PMC4028981] [PubMed: 24456340]	- Population not relevant to this review protocol Squamous cell carcinoma in the head and neck (comparing narrow band magnified imaging with white light imaging)
Codipilly, D. C., Krishna Chandar, A., Wang, K. K. et al (2022) Wide-area transepithelial sampling for dysplasia detection in Barrett’s esophagus: a systematic review and meta-analysis. Gastrointestinal Endoscopy 95(1): 51–59.e7 [PMC free article: PMC8671247] [PubMed: 34543648]	- Systematic review used as source of primary studies
Curvers, W. L., Alvarez Herrero, L., Wallace, M. B. et al (2010) Endoscopic tri-modal imaging is more effective than standard endoscopy in identifying early-stage neoplasia in Barrett’s esophagus. Gastroenterology 139(4): 1106–1114 [PubMed: 20600033]	- Data not reported in an extractable format or a format that can be analysed only partial results reported with false positive
Curvers, W. L., Bohmer, C. J., Mallant-Hent, R. C. et al (2008) Mucosal morphology in Barrett’s esophagus: interobserver agreement and role of narrow band imaging. Endoscopy 40(10): 799–805 [PubMed: 18828075]	- Study design not relevant to this review protocol assessing inter observer agreement for proposed morphological classification, comparing white light imaging with narrow band imaging.
Curvers, W., Baak, L., Kiesslich, R. et al (2008) Chromoendoscopy and narrow-band imaging compared with high-resolution magnification endoscopy in Barrett’s esophagus. Gastroenterology 134(3): 670–9 [PubMed: 18242603]	- Study design not relevant to this review protocol no relevant outcomes - comparing the interobserver agreement between different modalities only. No diagnostic accuracy data.
Dave, U.; Shousha, S.; Westaby, D. (2001) Methylene blue staining: is it really useful in Barrett’s esophagus?. Gastrointestinal Endoscopy 53(3): 333–335 [PubMed: 11231393]	- Data not reported in an extractable format or a format that can be analysed not clear comparison to reference standard
de Groof, A. J., Struyvenberg, M. R., Fockens, K. N. et al (2020) Deep learning algorithm detection of Barrett’s neoplasia with high accuracy during live endoscopic procedures: a pilot study (with video). Gastrointestinal Endoscopy 91(6): 1242–1250 [PubMed: 31926965]	- Study design not relevant to this review protocol white light imaging + blue light imaging tested against a computer aided design software
de Groof, A. J., Swager, A. F., Pouw, R. E. et al (2019) Blue-light imaging has an additional value to white-light endoscopy in visualization of early Barrett’s neoplasia: an international multicenter cohort study. Gastrointestinal Endoscopy 89(4): 749–758 [PubMed: 30419218]	- Study design not relevant to this review protocol assessing correlation of specialists views and agreement on endoscopy results
de Groof, J., van der Sommen, F., van der Putten, J. et al (2019) The Argos project: The development of a computer-aided detection system to improve detection of Barrett’s neoplasia on white light endoscopy. United European Gastroenterology Journal 7(4): 538–547 [PMC free article: PMC6488793] [PubMed: 31065371]	- Study design not relevant to this review protocol using previous endoscopy images to develop a computer aided software to detect Barrett’s oesophagus; the population from which images were obtained was not defined.
Diao, W., Huang, X., Shen, L. et al (2018) Diagnostic ability of blue laser imaging combined with magnifying endoscopy for early esophageal cancer. Digestive & Liver Disease 50(10): 1035–1040 [PubMed: 29685806]	- Population not relevant to this review protocol general population under investigation - not specific to Barrett’s oesophagus patients
Dobashi, A., Goda, K., Furuhashi, H. et al (2019) Diagnostic efficacy of dual-focus endoscopy with narrow-band imaging using simplified dyad criteria for superficial esophageal squamous cell carcinoma. Journal of Gastroenterology 54(6): 501–510 [PubMed: 30406847]	- Population not relevant to this review protocol investigating participants with or for squamous cell oesophageal carcinoma
Dutta, A. K., Sajith, K. G., Pulimood, A. B. et al (2013) Narrow band imaging versus white light gastroscopy in detecting potentially premalignant gastric lesions: a randomized prospective crossover study. Indian Journal of Gastroenterology 32(1): 37–42 [PubMed: 22983839]	- Population not relevant to this review protocol gastric examination via gastroscopy for gastric cancers
Ebi, M., Shimura, T., Yamada, T. et al (2015) Multicenter, prospective trial of white-light imaging alone versus white-light imaging followed by magnifying endoscopy with narrow-band imaging for the real-time imaging and diagnosis of invasion depth in superficial esophageal squamous cell carcinoma. Gastrointestinal Endoscopy 81(6): 1355–1361.e2 [PubMed: 25683023]	- Population not relevant to this review protocol squamous cell carcinoma only
Elsheaita, A., El-Bially, M. A., Shamseya, M. M. et al (2020) Seattle protocol vs narrow band imaging guided biopsy in screening of Barrett’s esophagus in gastroesophageal reflux disease patients. Medicine (United States) 99 (8) [PMC free article: PMC7034706] [PubMed: 32080134]	- Population not relevant to this review protocol patients with known Barrett’s Oesophagus were excluded
Everson, M. A., Lovat, L. B., Graham, D. G. et al (2019) Virtual chromoendoscopy by using optical enhancement improves the detection of Barrett’s esophagus-associated neoplasia. Gastrointestinal Endoscopy 89(2): 247–256.e4 [PubMed: 30291849]	- Study design not relevant to this review protocol diagnostic accuracy of different endoscopists in detecting dysplasia from images obstained from HD imaging or iScan images + interobserver agreement.
Ezoe, Y., Muto, M., Uedo, N. et al (2011) Magnifying narrowband imaging is more accurate than conventional white-light imaging in diagnosis of gastric mucosal cancer. Gastroenterology 141(6): 2017–2025.e3 [PubMed: 21856268]	- Population not relevant to this review protocol gastric mucosal cancer
Gai, W., Jin, X. F., Du, R. et al (2018) Efficacy of narrow-band imaging in detecting early esophageal cancer and risk factors for its occurrence. Indian Journal of Gastroenterology 37(2): 79–85 [PubMed: 29516416]	- Population not relevant to this review protocol population mainly made up of squamous cell carcinoma of the head and neck
Gangarosa, L. M.; Halter, S.; Mertz, H. (2000) Methylene blue staining and endoscopic ultrasound evaluation of Barrett’s esophagus with low-grade dysplasia. Digestive Diseases & Sciences 45(2): 225–9 [PubMed: 10711429]	- Study design not relevant to this review protocol no comparator
Ghatwary, N.; Zolgharni, M.; Ye, X. (2019) Early esophageal adenocarcinoma detection using deep learning methods. International Journal of Computer Assisted Radiology & Surgery 14(4): 611–621 [PMC free article: PMC6420905] [PubMed: 30666547]	- Study design not relevant to this review protocol deep learning neural networks tested to see if they can detect esophageal cancer from HD-white light imaging done previously (not at the same time)
Giacchino, M., Bansal, A., Kim, R. E. et al (2013) Clinical utility and interobserver agreement of autofluorescence imaging and magnification narrow-band imaging for the evaluation of Barrett’s esophagus: a prospective tandem study. Gastrointestinal Endoscopy 77(5): 711–8 [PubMed: 23433595]	- Study design not relevant to this review protocol Unclear if HD white light imaging is being used as a reference standard, as all biopsies were taken from AFI or NBI (from those seen as reactive)
Gilani, N., Stipho, S., Shaukat, M. S. et al (2007) The yield and safety of string capsule endoscopy in patients with dysphagia. Gastrointestinal Endoscopy 66(6): 1091–5 [PubMed: 18028926]	- Population not relevant to this review protocol Patients with oesophageal symptoms - not Barrett’s Oesophagus
Goda, K., Takeuchi, M., Ishihara, R. et al (2021) Diagnostic utility of a novel magnifying endoscopic classification system for superficial Barrett’s esophagus-related neoplasms: a nationwide multicenter study. Esophagus 30: 30 [PMC free article: PMC8387266] [PubMed: 34052965]	- Study design not relevant to this review protocol validation and test phase of criteria to diagnose HD-narrow band images for superficial non dysplastic Barrett’s
Gralnek, I. M., Adler, S. N., Yassin, K. et al (2008) Detecting esophageal disease with second-generation capsule endoscopy: initial evaluation of the PillCam ESO 2. Endoscopy 40(4): 275–279 [PubMed: 18389444]	- Incorrect target condition: not dysplasia
Guo, J., Li, C. Q., Li, M. et al (2015) Diagnostic value of probe-based confocal laser endomicroscopy and high-definition virtual chromoendoscopy in early esophageal squamous neoplasia. Gastrointestinal Endoscopy 81(6): 1346–54 [PubMed: 25680899]	- Population not relevant to this review protocol Squamous cell carcinoma
Hamamoto, Y., Endo, T., Nosho, K. et al (2004) Usefulness of narrow-band imaging endoscopy for diagnosis of Barretts’s esophagus. Journal of Gastroenterology 39(1): 14–20 [PubMed: 14767729]	- Data not reported in an extractable format or a format that can be analysed diagnostic accuracy data not reported
Haringsma, J. (2002) Barrett’s oesophagus: New diagnostic and therapeutic techniques. Scandinavian Journal of Gastroenterology, Supplement 37(236): 9–14 [PubMed: 12408497]	- Review article but not a systematic review
Heresbach, D., Leray, E., d’Halluin, P. N. et al (2010) Diagnostic accuracy of esophageal capsule endoscopy versus conventional upper digestive endoscopy for suspected esophageal squamous cell carcinoma. Endoscopy 42(2): 93–7 [PubMed: 20140825]	- Population not relevant to this review protocol investigating squamous cell carcinoma
Hirst, N. G., Gordon, L. G., Whiteman, D. C. et al (2011) Is endoscopic surveillance for non-dysplastic Barrett’s esophagus cost-effective? Review of economic evaluations. Journal of Gastroenterology & Hepatology 26(2): 247–54 [PubMed: 21261712]	- Study design not relevant to this review protocol cost effectiveness analysis
Hoffman, A., Kiesslich, R., Bender, A. et al (2006) Acetic acid-guided biopsies after magnifying endoscopy compared with random biopsies in the detection of Barrett’s esophagus: a prospective randomized trial with crossover design. Gastrointestinal Endoscopy 64(1): 1–8 [PubMed: 16813794]	- Study design not relevant to this review protocol Diagnostic analysis unclear. Reports sensitivity stratified by Guelrud Classification
Horie, Y., Yoshio, T., Aoyama, K. et al (2019) Diagnostic outcomes of esophageal cancer by artificial intelligence using convolutional neural networks. Gastrointestinal Endoscopy 89(1): 25–32 [PubMed: 30120958]	- Population not relevant to this review protocol mixed population of squamous and adenocarcinoma, results not stratified
Horwhat, J. D., Maydonovitch, C. L., Ramos, F. et al (2008) A randomized comparison of methylene blue-directed biopsy versus conventional four-quadrant biopsy for the detection of intestinal metaplasia and dysplasia in patients with long-segment Barrett’s esophagus. American Journal of Gastroenterology 103(3): 546–554 [PubMed: 17970838]	- Data not reported in an extractable format or a format that can be analysed only reports sensitivities and no raw data for analysis
Ikenoyama, Y., Yoshio, T., Tokura, J. et al (2021) Artificial intelligence diagnostic system predicts multiple Lugol-voiding lesions in the esophagus and patients at high risk for esophageal squamous cell carcinoma. Endoscopy 04: 04 [PubMed: 33540446]	- Population not relevant to this review protocol Squamous cell carcinoma
Imaeda, H., Hosoe, N., Kashiwagi, K. et al (2014) Surveillance using trimodal imaging endoscopy after endoscopic submucosal dissection for superficial gastric neoplasia. World Journal of Gastroenterology 20(43): 16311–7 [PMC free article: PMC4239523] [PubMed: 25473189]	- Population not relevant to this review protocol investigating imaging techniques for gastric cancer
Ishimura, N., Amano, Y., Uno, G. et al (2012) Endoscopic characteristics of short-segment Barrett’s esophagus, focusing on squamous islands and mucosal folds. Journal of Gastroenterology & Hepatology 27suppl3: 82–7 [PubMed: 22486877]	- Population not relevant to this review protocol Squamous cell carcinoma
Iwagami, H., Ishihara, R., Aoyama, K. et al (2021) Artificial intelligence for the detection of esophageal and esophagogastric junctional adenocarcinoma. Journal of Gastroenterology & Hepatology 36(1): 131–136 [PubMed: 32511793]	- Study design not relevant to this review protocol AI software diagnostic accuracy compared with white light imaging OR narrow band imaging
Johanson, J. F.; Frakes, J.; Eisen, D. (2011) Computer-assisted analysis of abrasive transepithelial brush biopsies increases the effectiveness of esophageal screening: a multicenter prospective clinical trial by the endocdx collaborative group. Digestive Diseases and Sciences 56(3): 767–772 [PubMed: 21132367]	- Study does not contain an intervention relevant to this review protocol forceps biopsy vs brush biopsies (not clear if using WLI as comparison). Also, mixed population with non BE participants for general investigation.
Kara, M. A., Peters, F. P., Ten Kate, F. J. W. et al (2005) Endoscopic video autofluorescence imaging may improve the detection of early neoplasia in patients with Barrett’s esophagus. Gastrointestinal Endoscopy 61(6): 679–685 [PubMed: 15855971]	- Data not reported in an extractable format or a format that can be analysed only some analysis of diagnostic data provided narratively - not enough for calculation
Katada, C., Tanabe, S., Wada, T. et al (2019) Retrospective Assessment of the Diagnostic Accuracy of the Depth of Invasion by Narrow Band Imaging Magnifying Endoscopy in Patients with Superficial Esophageal Squamous Cell Carcinoma. Journal of Gastrointestinal Cancer 50(2): 292–297 [PubMed: 29435906]	- Population not relevant to this review protocol Squamous cell carcinoma
Kaul, V., Gross, S., Corbett, F. S. et al (2020) Clinical utility of wide-area transepithelial sampling with three-dimensional computer-assisted analysis (WATS3D) in identifying Barrett’s esophagus and associated neoplasia. Diseases of the Esophagus 33 (12) [PubMed: 32607543]	- Study does not contain an intervention relevant to this review protocol no comparison to white light imaging
Kodashima, S., Fujishiro, M., Ono, S. et al (2014) Evaluation of a new image-enhanced endoscopic technology using band-limited light for detection of esophageal squamous cell carcinoma. Digestive Endoscopy 26(2): 164–71 [PubMed: 23621480]	- Population not relevant to this review protocol Squamous cell carcinoma
Kouklakis, G. S., Kountouras, J., Dokas, S. M. et al (2003) Methylene blue chromoendoscopy for the detection of Barrett’s esophagus in a Greek cohort. Endoscopy 35(5): 383–7 [PubMed: 12701007]	- Data not reported in an extractable format or a format that can be analysed no diagnostic accuracy data
Kuraoka, K., Hoshino, E., Tsuchida, T. et al (2009) Early esophageal cancer can be detected by screening endoscopy assisted with narrow-band imaging (NBI). Hepato-Gastroenterology 56(89): 63–6 [PubMed: 19453030]	- Population not relevant to this review protocol participants under investigation for high risk of oesophageal cancer (not Barrett’s Oesophagus surveillance)
Lee, C. T., Chang, C. Y., Lee, Y. C. et al (2010) Narrow-band imaging with magnifying endoscopy for the screening of esophageal cancer in patients with primary head and neck cancers. Endoscopy 42(8): 613–9 [PubMed: 20669074]	- Population not relevant to this review protocol majority of participants not Barrett’s Oesophagus (2 out of 68)
Leggett, C. L., Gorospe, E. C., Chan, D. K. et al (2016) Comparative diagnostic performance of volumetric laser endomicroscopy and confocal laser endomicroscopy in the detection of dysplasia associated with Barrett’s esophagus. Gastrointestinal Endoscopy 83(5): 880–888.e2 [PMC free article: PMC5554864] [PubMed: 26344884]	- Study does not contain an intervention relevant to this review protocol probe based confocal laser endomicroscopy compared with volumetric laser endomicrosocopy (not compared to white light imaging)
Li, B., Cai, S. L., Tan, W. M. et al (2021) Comparative study on artificial intelligence systems for detecting early esophageal squamous cell carcinoma between narrow-band and white-light imaging. World Journal of Gastroenterology 27(3): 281–293 [PMC free article: PMC7814365] [PubMed: 33519142]	- Population not relevant to this review protocol Squamous cell carcinoma
Li, H. Y., Dai, J., Xue, H. B. et al (2012) Application of magnifying endoscopy with narrow-band imaging in diagnosing gastric lesions: a prospective study. Gastrointestinal Endoscopy 76(6): 1124–32 [PubMed: 23025977]	- Population not relevant to this review protocol investigating for gastric cancer
Lin, O. S., Schembre, D. B., Mergener, K. et al (2007) Blinded comparison of esophageal capsule endoscopy versus conventional endoscopy for a diagnosis of Barrett’s esophagus in patients with chronic gastroesophageal reflux. Gastrointestinal Endoscopy 65(4): 577–583 [PubMed: 17324414]	- Incorrect target condition: not dysplasia
Liu, G., Hua, J., Wu, Z. et al (2020) Automatic classification of esophageal lesions in endoscopic images using a convolutional neural network. Annals of Translational Medicine 8(7): 486 [PMC free article: PMC7210177] [PubMed: 32395530]	- Study does not contain an intervention relevant to this review protocol building a computer based neural network to appropriately diagnose lesions via AI. Reference images a mixed population of White light imaging, narrow band imaging and Autofluorescence.
Lui, T. K. L.; Tsui, V. W. M.; Leung, W. K. (2020) Accuracy of artificial intelligence-assisted detection of upper GI lesions: a systematic review and meta-analysis. Gastrointestinal Endoscopy 92(4): 821–830.e9 [PubMed: 32562608]	- Systematic review used as source of primary studies
Mayinger, B., Oezturk, Y., Stolte, M. et al (2006) Evaluation of sensitivity and inter- and intra-observer variability in the detection of intestinal metaplasia and dysplasia in Barrett’s esophagus with enhanced magnification endoscopy. Scandinavian Journal of Gastroenterology 41(3): 349–356 [PubMed: 16497625]	- Data not reported in an extractable format or a format that can be analysed diagnostic data reported according to experience and inter observer agreement between blinding
Ngamruengphong, S.; Sharma, V. K.; Das, A. (2009) Diagnostic yield of methylene blue chromoendoscopy for detecting specialized intestinal metaplasia and dysplasia in Barrett’s esophagus: a meta-analysis. Gastrointestinal Endoscopy 69(6): 1021–8 [PubMed: 19215918]	- Systematic review used as source of primary studies
Ohmori, M., Ishihara, R., Aoyama, K. et al (2020) Endoscopic detection and differentiation of esophageal lesions using a deep neural network. Gastrointestinal Endoscopy 91(2): 301–309.e1 [PubMed: 31585124]	- Study not reported in English
Qumseya, B. J., Wang, H., Badie, N. et al (2013) Advanced imaging technologies increase detection of dysplasia and neoplasia in patients with Barrett’s esophagus: a meta-analysis and systematic review. Clinical Gastroenterology & Hepatology 11(12): 1562–70.e1 [PMC free article: PMC3910269] [PubMed: 23851020]	- Systematic review used as source of primary studies
Rogart, J. N.; Aslanian, H. R.; Siddiqui, U. D. (2011) Narrow band imaging to detect residual or recurrent neoplastic tissue during surveillance endoscopy. Digestive Diseases and Sciences 56(2): 472–478 [PubMed: 20532981]	- Population not relevant to this review protocol gastric or colorectal cancer
Ross-Innes, C. S., Debiram-Beecham, I., O’Donovan, M. et al (2015) Evaluation of a minimally invasive cell sampling device coupled with assessment of trefoil factor 3 expression for diagnosing Barrett’s esophagus: a multi-center case-control study. PLoS Medicine / Public Library of Science 12(1): e1001780 [PMC free article: PMC4310596] [PubMed: 25634542]	- Comparator in study does not match that specified in this review protocol non endoscopic cell collection device compared to endoscopic
Sami, S. S., Subramanian, V., Butt, W. M. et al (2015) High definition versus standard definition white light endoscopy for detecting dysplasia in patients with Barrett’s esophagus. Diseases of the Esophagus 28(8): 742–749 [PubMed: 25209721]	- Study does not contain an intervention relevant to this review protocol high resolution white light endoscopy compared to standard endoscopy white light endoscopy
Saxena, P. and Canto, M. I. (2013) Red flag imaging techniques in Barrett’s esophagus. Gastrointestinal Endoscopy Clinics of North America 23(3): 535–47 [PubMed: 23735101]	- Review article but not a systematic review
Shah, T., Lippman, R., Kohli, D. et al (2018) Accuracy of probe-based confocal laser endomicroscopy (pCLE) compared to random biopsies during endoscopic surveillance of Barrett’s esophagus. Endoscopy International Open 6(4): E414-E420 [PMC free article: PMC5876024] [PubMed: 29607393]	- Study design not relevant to this review protocol white light imaging and narrow band imaging compared to probe based confocal laser endomicroscopy
Shariff, M. K., Bird-Lieberman, E. L., O’Donovan, M. et al (2012) Randomized crossover study comparing efficacy of transnasal endoscopy with that of standard endoscopy to detect Barrett’s esophagus. Gastrointestinal Endoscopy 75(5): 954–961 [PubMed: 22421496]	- Incorrect target condition: not dysplasia
Sharma, P., Wani, S., Rastogi, A. et al (2008) The diagnostic accuracy of esophageal capsule endoscopy in patients with gastroesophageal reflux disease and Barrett’s esophagus: a blinded, prospective study. American Journal of Gastroenterology 103(3): 525–32 [PubMed: 17459025]	- Incorrect target condition: not dysplasia
Singh, R., Jayanna, M., Wong, J. et al (2015) Narrow-band imaging and white-light endoscopy with optical magnification in the diagnosis of dysplasia in Barrett’s esophagus: results of the Asia-Pacific Barrett’s Consortium. Endoscopy International Open 3(1): E14–8 [PMC free article: PMC4423324] [PubMed: 26134765]	- Study design not relevant to this review protocol comparison of interobserver agreement and diagnostic accuracy of different endoscopists to identify the histology
Singh, R., Karageorgiou, H., Owen, V. et al (2009) Comparison of high-resolution magnification narrow-band imaging and white-light endoscopy in the prediction of histology in Barrett’s oesophagus. Scandinavian Journal of Gastroenterology 44(1): 85–92 [PubMed: 18821132]	- Study design not relevant to this review protocol prediction of morphology by multiple endoscopists to differentiate between WLI and NBI
Smith, M. S., Ikonomi, E., Bhuta, R. et al (2019) Wide-area transepithelial sampling with computer-assisted 3-dimensional analysis (WATS) markedly improves detection of esophageal dysplasia and Barrett’s esophagus: Analysis from a prospective multicenter community-based study. Diseases of the Esophagus 32(3) [PMC free article: PMC6403460] [PubMed: 30541019]	- Data not reported in an extractable format or a format that can be analysed detection rates of yield with WATS3D and forceps biopsy
Song, J., Zhang, J., Wang, J. et al (2015) Meta-analysis of the effects of endoscopy with narrow band imaging in detecting dysplasia in Barrett’s esophagus. Diseases of the Esophagus 28(6): 560–6 [PubMed: 24758693]	- Systematic review used as source of primary studies
Struyvenberg, M. R., de Groof, A. J., van der Putten, J. et al (2021) A computer-assisted algorithm for narrow-band imaging-based tissue characterization in Barrett’s esophagus. Gastrointestinal Endoscopy 93(1): 89–98 [PubMed: 32504696]	- Study design not relevant to this review protocol computer aided diagnosis using previous images from white light imaging and narrow band imaging
Su, Z., Wang, L., Wei, S. et al (2019) Clinical diagnostic value of digestive endoscopic narrow-band imaging in early esophageal cancer. Oncology Letters 17(6): 5481–5486 [PMC free article: PMC6507488] [PubMed: 31186767]	- Study design not relevant to this review protocol case control study comparing narrow band imaging with white light images as control (unclear if patients underwent both procedures)
Suzuki, H., Saito, Y., Ikehara, H. et al (2009) Evaluation of visualization of squamous cell carcinoma of esophagus and pharynx using an autofluorescence imaging videoendoscope system. Journal of Gastroenterology & Hepatology 24(12): 1834–9 [PubMed: 19780882]	- Population not relevant to this review protocol squamous cell carcinoma
Tanaka, T., Niwa, Y., Tajika, M. et al (2014) Prospective evaluation of a transnasal endoscopy utilizing flexible spectral imaging color enhancement (FICE) with the Valsalva maneuver for detecting pharyngeal and esophageal cancer. Hepato-Gastroenterology 61(134): 1627–34 [PubMed: 25436354]	- Population not relevant to this review protocol investigation of head and neck cancer with squamous cell carcinoma
Thota, P. N., Zuccaro Jr, G., Vargo, Ii J. J. et al (2005) A randomized prospective trial comparing unsedated esophagoscopy via transnasal and transoral routes using a 4-mm video endoscope with conventional endoscopy with sedation. Endoscopy 37(6): 559–565 [PubMed: 15933930]	- Study design not relevant to this review protocol general investigation for multiple gastrooesophageal conditions
Tokai, Y., Yoshio, T., Aoyama, K. et al (2020) Application of artificial intelligence using convolutional neural networks in determining the invasion depth of esophageal squamous cell carcinoma. Esophagus 17(3): 250–256 [PubMed: 31980977]	- Population not relevant to this review protocol Squamous cell carcinoma
Tomie, A., Dohi, O., Yagi, N. et al (2016) Blue Laser Imaging-Bright Improves Endoscopic Recognition of Superficial Esophageal Squamous Cell Carcinoma. Gastroenterology Research and Practice 2016 (no pagination) [PMC free article: PMC5055998] [PubMed: 27738428]	- Population not relevant to this review protocol squamous cell carcinoma
Tsoi, E. H., Fehily, S., Williams, R. et al (2019) Diffuse endoscopically visible, predominantly low grade dysplasia in Barrett’s esophagus (with video). Endoscopy International Open 7(12): E1742–E1747 [PMC free article: PMC6904234] [PubMed: 31828211]	- Study design not relevant to this review protocol non comparative study
Uedo, N., Iishi, H., Tatsuta, M. et al (2005) A novel videoendoscopy system by using autofluorescence and reflectance imaging for diagnosis of esophagogastric cancers. Gastrointestinal Endoscopy 62(4): 521–8 [PubMed: 16185965]	- Data not reported in an extractable format or a format that can be analysed incomplete data reported
Ueyama, H., Kato, Y., Akazawa, Y. et al (2021) Application of artificial intelligence using a convolutional neural network for diagnosis of early gastric cancer based on magnifying endoscopy with narrow-band imaging. Journal of Gastroenterology & Hepatology 36(2): 482–489 [PMC free article: PMC7984440] [PubMed: 32681536]	- Population not relevant to this review protocol investigation for gastric cancer
Van Der Sommen, F., Zinger, S., Curvers, W. L. et al (2016) Computer-aided detection of early neoplastic lesions in Barrett’s esophagus. Endoscopy 48(7): 617–624 [PubMed: 27100718]	- Incorrect target condition: not dysplasia
Vazquez-Iglesias, J. L., Alonso-Aguirre, P., Diz-Lois, M. T. et al (2007) Acetic acid allows effective selection of areas for obtaining biopsy samples in Barrett’s esophagus. European Journal of Gastroenterology & Hepatology 19(3): 187–93 [PubMed: 17301644]	- Comparator in study does not match that specified in this review protocol unclear if white light imaging was used as a reference standard for comparison
Verna, C., Feyles, E., Lorenzi, L. et al (2014) I-SCAN targeted versus random biopsies in Barrett’s oesophagus. Digestive and Liver Disease 46(2): 131–134 [PubMed: 24239042]	- Data not reported in an extractable format or a format that can be analysed only reports inter-observer agreement
Visaggi, P., Barberio, B., Gregori, D. et al (2022) Systematic review with meta-analysis: artificial intelligence in the diagnosis of oesophageal diseases. Alimentary pharmacology & therapeutics [PMC free article: PMC9305819] [PubMed: 35098562]	- Systematic review used as source of primary studies
Wang, F., Liu, P., Zhao, K. et al (2016) Magnifying endoscopy combined with narrow-band imaging for targeted biopsy of superficial lesions in esophagus. Chinese journal of gastroenterology 21(10): 597–601	- Study not reported in English
Wang, Y. K., Syu, H. Y., Chen, Y. H. et al (2021) Endoscopic Images by a Single-Shot Multibox Detector for the Identification of Early Cancerous Lesions in the Esophagus: A Pilot Study. Cancers 13(2): 17 [PMC free article: PMC7830509] [PubMed: 33477274]	- Population not relevant to this review protocol Squamous cell carcinoma
Watanabe, A., Taniguchi, M., Tsujie, H. et al (2008) The value of narrow band imaging endoscope for early head and neck cancers. Otolaryngology - Head & Neck Surgery 138(4): 446–51 [PubMed: 18359352]	- Study does not contain an intervention relevant to this review protocol rhinolaryngo-videoscopic examinations for head and neck cancers
Waxman, I., Raju, G. S., Critchlow, J. et al (2006) High-frequency probe ultrasonography has limited accuracy for detecting invasive adenocarcinoma in patients with Barrett’s esophagus and high-grade dysplasia or intramucosal carcinoma: a case series. American Journal of Gastroenterology 101(8): 1773–9 [PubMed: 16780561]	- Data not reported in an extractable format or a format that can be analysed some data given, but unclear of diagnostic data for calculation
Wo, J. M., Ray, M. B., Mayfield-Stokes, S. et al (2001) Comparison of methylene blue-directed biopsies and conventional biopsies in the detection of intestinal metaplasia and dysplasia in Barrett’s esophagus: a preliminary study. Gastrointestinal Endoscopy 54(3): 294–301 [PubMed: 11522968]	- Population not relevant to this review protocol mixed population of patients with heartburn (investigation) and some Barrett’s (surveillance)
Wu, C. C. H., Namasivayam, V., Li, J. W. et al (2021) A prospective randomized tandem gastroscopy pilot study of linked color imaging versus white light imaging for detection of upper gastrointestinal lesions. Journal of Gastroenterology and Hepatology (Australia) [PubMed: 33811385]	- Population not relevant to this review protocol not investigating for barrett’s oesophagus
Wu, I. C., Syu, H. Y., Jen, C. P. et al (2018) Early identification of esophageal squamous neoplasm by hyperspectral endoscopic imaging. Scientific Reports 8(1): 13797 [PMC free article: PMC6138669] [PubMed: 30218087]	- Population not relevant to this review protocol Squamous cell carcinoma
Yang, S, Wu, S, Huang, Y et al (2012) Screening for oesophageal cancer. Cochrane Database of Systematic Reviews [PubMed: 23235651]	- Systematic review used as source of primary studies
Yang, X. X., Li, Z., Shao, X. J. et al (2020) Real-time artificial intelligence for endoscopic diagnosis of early esophageal squamous cell cancer (with video). Digestive Endoscopy 04: 04 [PubMed: 33275789]	- Population not relevant to this review protocol Squamous cell carcinoma
Yokoyama, A., Ichimasa, K., Ishiguro, T. et al (2012) Is it proper to use non-magnified narrow-band imaging for esophageal neoplasia screening? Japanese single-center, prospective study. Digestive Endoscopy 24(6): 412–418 [PubMed: 23078432]	- Population not relevant to this review protocol mixed results with squamous cell carcinoma, high grade and low grade neoplasia
Yoshimizu, S., Yamamoto, Y., Horiuchi, Y. et al (2018) Diagnostic performance of routine esophagogastroduodenoscopy using magnifying endoscope with narrow-band imaging for gastric cancer. Digestive Endoscopy 30(1): 71–78 [PubMed: 28685858]	- Population not relevant to this review protocol gastric cancer
Zhang, Q. W., Teng, L. M., Zhang, X. T. et al (2017) Narrow-band imaging in the diagnosis of deep submucosal colorectal cancers: a systematic review and meta-analysis. Endoscopy 49(6): 564–580 [PubMed: 28472835]	- Population not relevant to this review protocol SR for studies related to colorectal cancer
Zhang, S. M.; Wang, Y. J.; Zhang, S. T. (2021) Accuracy of artificial intelligence-assisted detection of esophageal cancer and neoplasms on endoscopic images: A systematic review and meta-analysis. Journal of Digestive Diseases 22(6): 318–328 [PMC free article: PMC8361665] [PubMed: 33871932]	- Systematic review used as source of primary studies

Evidence review for diagnostic accuracy of endoscopic surveillance techniques

1. Diagnostic accuracy of endoscopic surveillance techniques

1.1. Review question

1.1.1. Introduction

1.1.2. Methods and process

1.1.3. Summary of the protocol

Table 1

1.1.4. Diagnostic evidence

1.1.4.1. Included studies

1.1.4.2. Excluded studies

1.1.5. Summary of studies included in the diagnostic evidence

Table 2

1.1.6. Summary of the diagnostic evidence

Table 3

Table 4

Table 5

1.1.7. Economic evidence

1.1.7.1. Included studies

1.1.7.2. Excluded studies

1.1.8. Summary of included economic evidence

1.1.9. Economic model

1.1.10. Unit costs

Table

1.1.11. The committee’s discussion and interpretation of the evidence

1.1.11.1. The outcomes that matter most

1.1.11.2. The quality of the evidence

Chromoendoscopy

Endoscopic brushing

Artificial intelligence

1.1.11.3. Benefits and harms

Chromoendoscopy

Endoscopic brushing

Artificial Intelligence

Overall

1.1.11.4. Cost effectiveness and resource use

1.1.12. Recommendations supported by this evidence review

1.1.13. References

Appendices

Appendix A. Review protocols

Appendix B. Literature search strategies

B.1. Clinical search literature search strategy

B.2. Health Economics literature search strategy

Appendix C. Diagnostic evidence study selection

Appendix D. Diagnostic evidence

Appendix E. Sensitivity and specificity forest plots

E.1. Chromoendoscopy

E.2. Endoscopic brushing

E.3. Artificial intelligence

Appendix F. Economic evidence study selection

Appendix G. Excluded studies

Clinical studies

Table 8

Health Economic studies

Appendix H. Research recommendations

Endoscopic surveillance

Why this is important

Rationale for research recommendation

Modified PICO table

Table 1PICO characteristics of review question

Table 2Summary of studies included in the evidence review

Table 3Clinical evidence summary: diagnostic test accuracy for chromoendoscopy

Table 4Clinical evidence summary: diagnostic test accuracy for endoscopic brushing

Table 5Clinical evidence summary: diagnostic test accuracy for artificial intelligence

Table 8Studies excluded from the clinical review