Value of contrast‐enhanced harmonic endoscopic ultrasonography in differentiating between gastrointestinal stromal tumors: A meta‐analysis

Objective Contrast‐enhanced harmonic endoscopic ultrasonography (CH‐EUS) is a valuable device to diagnose and determine the malignant potential of gastrointestinal stromal tumors (GIST) as early as possible when making clinical therapeutic decisions. This study aimed to estimate the ability of CH‐EUS to discriminate between GIST and benign submucosal lesions (SML) and to predict their malignant potential. Methods PubMed, MEDLINE, EMBASE, the Web of Science, and Cochrane Central Register of Controlled Trials databases were screened. Using the data provided in the literatures, 2 × 2 tables were constructed to obtain the pooled sensitivity, specificity, positive likelihood ratio, and negative likelihood ratio. A receiver operating characteristic (ROC) curve was generated and the area under the ROC curve (AUROC) was calculated. Results Four studies with a total of 187 patients were identified to evaluate the value of CH‐EUS in discriminating between GIST and benign SML. The pooled sensitivity, specificity, and AUROC were 89% (95% CI 0.82‐0.93), 82% (95% CI 0.66‐0.92), and 0.89, respectively. Five studies including 143 patients were analyzed to assess the accuracy of CH‐EUS in determining the malignant potential of GIST. The pooled sensitivity, specificity, and AUROC curve of CH‐EUS were 96% (95% CI 0.90‐0.99), 53% (95% CI 0.40‐0.66), and 0.92, respectively. Conclusions CH‐EUS is a safe, noninvasive method that can distinguish between GIST and benign subepithelial lesions and to predict their malignant potential to a certain extent. Large‐scale, multicenter prospective studies are needed in the future.