Narrow-band imaging (NBI) is a noninvasive, accurate technique for identifying and excluding duodenal villous atrophy among individuals displaying symptoms of celiac disease (CeD), according to study results published in Digestive and Liver Disease.
Researchers conducted a systematic review and meta-analysis and reported on the diagnostic precision of NBI in identifying duodenal villous atrophy among individuals with presumed CeD in comparison to intestinal biopsy as the established reference standard.
Of the 1078 records that were identified, the final analysis included a total of 6 studies comprising 540 participants.
In the studies included, the overall prevalence of duodenal villous atrophy was 43% (95% CI, 9%-77%), although there was significant variation among them (I2=99.3%). NBI exhibited a high sensitivity of 93% (95% CI, 81%-98%) and specificity of 95% (95% CI, 92%-98%), accompanied by a positive likelihood ratio (LR+) of 20.1 (95% CI, 10.6-38.2) and a negative likelihood ratio (LR-) of 0.07 (95% CI, 0.03-0.21).
The diagnostic odds ratio was 276 (95% CI, 64-1195), and the area under the summary receiver operating characteristic curve was 0.98 (95% CI, 96-99).
Moreover, NBI demonstrated a high unconditional positive predictive value (PPV) of 94% (95% CI, 92%-97%) and a negative predictive value (NPV) of 92% (95% CI, 90%-94%), indicating its effectiveness in both confirming and ruling out villous atrophy.
The study found moderate heterogeneity among different sensitivity studies (I2=42.7%) and low heterogeneity for specificity (I2=10.8%). No overall heterogeneity was detected (I2=0%).
Excluding 2 outlier studies eliminated heterogeneity for both sensitivity (I2=0%) and specificity (I2=0%). This resulted in a summary sensitivity of 94% (95% CI, 90%-97%) and a summary specificity of 94% (95% CI, 89%-98%).
Removing a study on pediatric patients improved the diagnostic performance of NBI, with a summary sensitivity of 95% (95% CI, 90%-97%) and specificity of 96% (95% CI, 92%-98%).
Subgroup analysis based on adjuvant techniques showed that NBI-ME had a summary sensitivity of 95% (95% CI, 91%-98%) and specificity of 97% (95% CI, 93%-98%), while NBI with water immersion had a summary sensitivity of 74% (95% CI, 57%-87%) and specificity of 100% (95% CI, 48%-100%).
NBI alone demonstrated a summary sensitivity of 89% (95% CI, 65%-99%) and specificity of 93% (95% CI, 85%-97%).
Excluding high-risk bias studies resulted in a decrease in NBI’s sensitivity to 88% (95% CI, 71%-96%). However, its specificity remained high at 94% (95% CI, 89%-97%) without any concerns regarding applicability in any of the studies.
This study may be limited by the absence of standardized NBI classification across studies in adjuvant endoscopic techniques.
The researchers concluded, “Nonetheless, the high accuracy of NBI could enable endoscopists to take targeted biopsies from areas with suspected VA. This could reduce the reliance on random biopsies and increase the chance of obtaining accurate samples.”
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