Critical appraisal:Bennett C, Green S, Decaestecker J, Almond M, Barr H, Bhandari P, et al 2012 3

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Critical Appraisal

Article being appraised

Bennett C, Green S, Decaestecker J, Almond M, Barr H, Bhandari P, et al. Surgery versus radical endotherapies for early cancer and high-grade dysplasia in Barrett's oesophagus. Cochrane Database Syst Rev 2012 Nov 14;11:CD007334 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/23152243.


Applicable clinical question

Key Facts

Study Design

systematic review — Cochrane analyses assessing the literature on the topic of surgery vs endotherapies for early cancer and HGD. There are no RCT - thus each section is a descriptive overview of a comparison of the two techniques.

Excluded 13 published studies comparing surgery and endotherapy in early cancer and HGD as all retrospective and non-randomised. Assessed that bias relates to selection to endoscopic therapy on the grounds of patient factors and not related to stage of disease. Excluded studies reported that patients having endotherapy were older, and had shorter segments of Barrett's. "impossible to reach firm comparison conclusions".

Number of Patients:

Not applicable


Includes an economic evaluation

yes

Evidence ratings

Level of evidence

III-2

Risk of bias
Low risk of bias Comments: The recommended evidence is that there is no Level I/II evidence for reasons given previously

Risk of bias assessment: systematic review

Studies included in the review
Was an adequate search strategy used?
Very thorough – included appropriate search terms and databases
Were the inclusion criteria appropriate and applied in an unbiased way?
Yes – pre-specified inclusion criteria applied independently by two people
Were the studies assessed for quality (relating to the minimisation of biases)?
Yes – appropriate quality issues were assessed independently by two people
Were the characteristics and results of individual studies appropriately summarised?
Yes – summary descriptive tables of subjects, interventions, outcomes etc are provided and estimates of treatment effect displayed
The following questions are only relevant for systematic reviews that pooled data
Were the methods used for pooling the data appropriate?
Yes
If there was heterogeneity, were sources of heterogeneity explored?
Yes
Size of effect
5 Reason for decision: There is no formal assessment of this in this review.
Relevance of evidence
2 Additional comments: Despite no randomised data the evidence suggests that endoscopic therapy is equivalent to eradication of HGD in the short term with few major side effects.
Result of appraisal

Jutta's tick icon.png Included




Completed by

Associate Professor Bernard Mark Smithers


Jutta's tick icon.png This appraisal has been completed.


Article
Bennett C, Green S, Decaestecker J, Almond M, Barr H, Bhandari P, et al. Surgery versus radical endotherapies for early cancer and high-grade dysplasia in Barrett's oesophagus. Cochrane Database Syst Rev 2012 Nov 14;11:CD007334 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/23152243.
Assigned to
User:Bernard.smithers
Topic area
Guidelines:Barrett's
Clinical question
Form
Form:Critical appraisal


Section below only relevant for Cancer Council Project Officer

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