Barrett's esophagus (BE) predisposes to the development of esophageal neoplasia, including high-grade dysplasia (HGD) and esophageal adenocarcinoma (EAC). A systematic literature review and meta-analysis were performed to assess the accuracy of within-patient comparisons of narrow band imaging (NBI) and confocal laser endomicroscopy (CLE) for diagnosis of HGD/EAC in patients with BE.

The following databases were examined up to April 2016 without language restriction: PubMed, Embase, Medline, Web of Science and the Cochrane Library. The QUADAS-2 tool for assessing the quality of included studies was used. The meta-analysis included pooled additional detection rate (ADR), diagnostic accuracy, and 95% confidence intervals (CI). The I² and Q-test were used to determine study heterogeneity.

Five studies involving 251 patients, reported within-patient comparisons of NBI and CLE, were eligible for meta-analysis. Compared with NBI, pooled ADR of CLE for per-lesion detection of neoplasia in patients with BE was 19.3% (95% CI: 0.05–0.33, I²=74.6%). The pooled sensitivity of NBI was 62.8% (95% CI: 0.56–0.69, I²=94.6%), which was lower (not significantly) than that of CLE (72.3%, 95% CI: 0.66–0.78, I²=89.3%). The pooled specificity of NBI and CLE were similar [85.3% (95% CI: 0.84–0.87, I²=92.1%) vs 83.8% (95% CI: 0.82–0.85, I²=96.8%)].

When compared with NBI, CLE significantly increased the per-lesion detection rate of esophageal neoplasia, HGD, and EAC in BE patients. Whether CLE is superior to NBI in neoplasia detection at per-patient level needs to be further investigated.