SynthesisDigestive diseases and sciences2026
Diagnostic Accuracy of Optical Endoscopic Evaluation and EUS for Differentiating T1a and T1b Barrett's Adenocarcinoma: A Systematic Review and Meta-Analysis.
Synthesis in Digestive diseases and sciences, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
BACKGROUND AND
aimsAccurate differentiation between T1a and T1b Barrett's adenocarcinoma (BAC) is essential for selecting endoscopic resection (ER) versus surgery. The diagnostic reliability of optical endoscopic evaluation (OEE) and endoscopic ultrasound (EUS) remains inconsistent. We performed a systematic review and meta-analysis to assess their diagnostic performance.
methodsPubMed, Embase, Scopus, and Cochrane were searched through December 2025. Studies evaluating OEE or EUS for differentiating T1a from T1b BAC were included. Pooled sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy were calculated using random-effects models. Heterogeneity was assessed with I
resultsNineteen studies (2,292 patients) were included. OEE showed pooled sensitivity of 55.3% and specificity of 75.1%, with accuracy of 63.1%. EUS demonstrated sensitivity of 66.1%, specificity of 89.3%, and accuracy of 82.8%. HSROC analysis showed no significant difference between modalities (AUC 0.69 vs 0.87; P = 1). Paris 0-I, 0-IIa, lesions with 0-IIc components, and BSL ≥ 3 cm were not associated with T1b invasion. Paris 0-IIb lesions were significantly less likely to harbor T1b disease (DOR 0.17, 95% CI 0.07-0.38).
conclusionsBoth OEE and EUS demonstrate modest accuracy for differentiating T1a from T1b BAC. Endoscopic morphology is not a reliable predictor of submucosal invasion, except for flat lesions being less likely T1b. ER remains essential for definitive staging.
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