Critical appraisal:Chang EY, Morris CD, Seltman AK, O'Rourke RW, Chan BK, Hunter JG, et al 2007 2

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Critical Appraisal

Article being appraised

Chang EY, Morris CD, Seltman AK, O'Rourke RW, Chan BK, Hunter JG, et al. The effect of antireflux surgery on esophageal carcinogenesis in patients with barrett esophagus: a systematic review. Ann Surg 2007 Jul;246(1):11-21 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/17592284.


Applicable clinical question

Key Facts

Study Design

systematic review — randomised and nonrandomised studies included

Number of Patients:

1696


Includes an economic evaluation

no

Evidence ratings

Level of evidence

I

Risk of bias
Moderate risk of bias Comments: A lot of heterogeneity between studies by explored this well

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?
Adequate – inclusion criteria were pre-specified and applied by one person
Were the studies assessed for quality (relating to the minimisation of biases)?
Adequate – some problems with quality issues or assessed by one person only
Were the characteristics and results of individual studies appropriately summarised?
Adequate – more information would be desirable
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
2 Reason for decision: statistically signif effect on marker of clinical endpoint (ie. dysplasia). Doesnt directly explore LGD sepaarately from HGD
Relevance of evidence
2 Additional comments: evidence of regression in surgical group (statistically significant) though other potential explanations
Result of appraisal

Jutta's tick icon.png Included




Completed by

Dr Andrew Taylor MBBS MD FRACP


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


Article
Chang EY, Morris CD, Seltman AK, O'Rourke RW, Chan BK, Hunter JG, et al. The effect of antireflux surgery on esophageal carcinogenesis in patients with barrett esophagus: a systematic review. Ann Surg 2007 Jul;246(1):11-21 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/17592284.
Assigned to
User:Andrew.taylor
Topic area
Guidelines:Barrett's
Clinical question
Form
Form:Critical appraisal


Section below only relevant for Cancer Council Project Officer

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