Poster Session I - A69 IMAGE-ENHANCED ENDOSCOPY VERSUS WHITE-LIGHT IMAGING FOR DETECTING EARLY GASTRIC CANCERS: A SYSTEMATIC REVIEW AND META-ANALYSIS

TL;DR

This study compares image-enhanced endoscopy to standard imaging for detecting early gastric cancer, finding a slight benefit from the enhanced method.

Contribution

A systematic review and meta-analysis evaluating the effectiveness of image-enhanced endoscopy for early gastric cancer detection.

Findings

IEE may slightly increase detection of early gastric cancer compared to WLI.

IEE also may slightly increase detection of neoplastic lesions.

Evidence for IEE's effect on H. pylori detection remains uncertain.

Abstract

Imaged-enhanced endoscopy (IEE) improves mucosal and vascular visualization, making subtle neoplasia easier to see. However, the advantage of IEE over white-light imaging (WLI) in detecting early gastric cancer remains unclear.

To assess the efficacy of IEE versus WLI for detecting early gastric cancer in patients who required esophagogastroduodenoscopy for screening, symptoms, or surveillance.

We performed a random-effect meta-analysis of randomized controlled trials (RCTs) identified in MEDLINE, Embase, CENTRAL databases from inception to August 2025. Primary outcome was detection of early gastric cancer; secondary outcomes were detection of neoplastic lesions (cancer, high-grade intraepithelial neoplasia, and low-grade intraepithelial neoplasia) and H. pylori infection. Subgroup analysis of IEE type was performed. Risk of bias was assessed with RoB2; certainty of evidence was rated with GRADE. Protocol was registered (CRD420251131986).

We included 10 trials with 15,044 patients. IEE may slightly increase detection of early gastric cancer (8 RCT: relative risk [RR] 1.29, 95% confidence interval [CI] 1.00–1.67; number needed to screen [NNS] 187, 95% CI 81–∞; low-certainty evidence). IEE also may slightly increase neoplastic lesions (8 RCT: RR 1.47, 95% CI 1.15–1.87; NNS 65, 95% CI 35–202; low-certainty evidence). Evidence for effect of IEE on H. pylori detection is uncertain (one RCT: RR 1.19, 95% CI 1.00–1.41; NNS 7, 95% CI 4–∞; very low-certainty evidence). Subgroup results differed by modality; linked color imaging showed a favorable trend, but superiority remains unproven. Limitations include high risk of bias and imprecision because of the low event rate.

IEE may slightly increase detection of early gastric cancer compared with WLI. Use of IEE can be considered in detecting early gastric cancer in high-risk populations.

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