Diagnostic value of X‐ray, endoscopy, and high‐resolution manometry for hiatal hernia: A systematic review and meta‐analysis

Background and Aim Hiatal hernia (HH) has been found in a large number of people, but there has been no unified way to diagnose it. The aim of this study was to compare the diagnostic efficiency of X‐ray, endoscopy, and high‐resolution manometry (HRM) in the diagnosis of HH using surgical diagnosis of HH as the gold standard. Methods Two biomedical databases (PubMed and EMBASE) were systematically searched through January 26, 2019. The pooled sensitivity, specificity, and area under the SROC curve (AUC) were calculated, and the AUC statistical significance was compared by Tukey's multiple comparisons test. Results A total of 5337 patients in seven articles were included. The pooled sensitivity, specificity, and AUC for X‐ray were 0.63 (0.46–0.77), 0.85 (0.69–0.94), and 0.80 (0.77–0.84), respectively, for diagnosing HH. The pooled estimates for endoscopy in diagnosing HH were as follows: sensitivity, 0.72 (0.39–0.91); specificity, 0.80 (0.70–0.87); and AUC, 0.82 (0.78–0.85). Similarly, the corresponding values for HRM were 0.77 (0.70–0.83); 0.92 (0.85–0.96), and 0.9527. Tukey's multiple comparisons tests were used to compare the AUCs of the three diagnostic methods: No significant differences were found between X‐ray and endoscopy (P = 0.7293), and HRM was superior to X‐ray (P = 0.0127) and endoscopy (P = 0.0442). Conclusions High‐resolution manometry may exhibit a better diagnostic performance for hiatal hernia. In contrast, X‐ray and endoscopy may not be the best methods, and there was no significant difference in diagnostic efficiency between the X‐ray and endoscopy.