Critical appraisal:Bulsiewicz WJ, Dellon ES, Rogers AJ, Pasricha S, Madanick RD, Grimm IS, et al 2012

From Clinical Guidelines Wiki

Critical Appraisal

Article being appraised

Bulsiewicz WJ, Dellon ES, Rogers AJ, Pasricha S, Madanick RD, Grimm IS, et al. The impact of endoscopic ultrasound findings on clinical decision making in Barrett's esophagus with high-grade dysplasia or early esophageal adenocarcinoma. Dis Esophagus 2012 Sep 27 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/23016606.


Applicable clinical question

Key Facts

Study Design

case series

Number of Patients:

135


Includes an economic evaluation

no

Evidence ratings

Level of evidence

IV

Risk of bias
High risk of bias Comments: Please replace this text and include any additional comments in regards to your quality rating

Risk of bias assessment: case series

Subject selection:
Highly selected or not described (e.g. single-institution study)
Were the outcome measures blind to pre/post-intervention?
No, but objective measures used
Follow-up complete and all patients included in the analysis?
Yes (follow-up >95%)
Size of effect
5 Reason for decision: Please replace this text and briefly describe the reasons for your rating
Relevance of evidence
2 Additional comments: Please replace this text and briefly describe the reasons for your rating
Result of appraisal

Jutta's tick icon.png Included



Comments

This retrospective single-centre case series of 135 patients with with Barrett's oesophagus and HGD or IMC undergoing EUS for staging examined the frequency in which EUS findings consistent with advanced disease (tumour invasion into SM, LN involvement, regional metastasis) led to a change in management. There were no EUS abnormalities in non-nodular Barrett's and 14% patients with nodular Barrett's had abnormal EUS findings. Among patients with nodular IMC, EUS and EMR demonstrated invasion in 24% and 40% respectively and of those with HGD, EUS and EMR demonstrated invasion in 9% and 0% respectively. In six cases, if EMR had not been performed, EUS would have
understaged the disease. Additionally, two of eight cases with EUS findings suggesting invasion were overstaged by EUS, resulting in esophagectomy. This study concluded that for patients with nodular neoplasia, EMR had greater utility than staging by EUS.

Completed by

Dr Jeremy Dwyer MBBS (Hons)


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


Article
Bulsiewicz WJ, Dellon ES, Rogers AJ, Pasricha S, Madanick RD, Grimm IS, et al. The impact of endoscopic ultrasound findings on clinical decision making in Barrett's esophagus with high-grade dysplasia or early esophageal adenocarcinoma. Dis Esophagus 2012 Sep 27 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/23016606.
Assigned to
User:Alan.moss
Topic area
Guidelines:Barrett's
Clinical question
Form
Form:Critical appraisal


Section below only relevant for Cancer Council Project Officer

Edit appraisal assignment