Critical appraisal:Curvers WL, ten Kate FJ, Krishnadath KK, Visser M, Elzer B, Baak LC, et al 2010 4

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Critical Appraisal

Article being appraised

Curvers WL, ten Kate FJ, Krishnadath KK, Visser M, Elzer B, Baak LC, et al. Low-grade dysplasia in Barrett's esophagus: overdiagnosed and underestimated. Am J Gastroenterol 2010 Jul;105(7):1523-30 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/20461069.


Applicable clinical question

Key Facts

Study Design

case-control study

Number of Patients:

22


Includes an economic evaluation

no

Evidence ratings

Level of evidence

III-2

Risk of bias
Moderate risk of bias Comments: some of endoscopy results were retrospective;

Risk of bias assessment: case-control study

Subject selection
Cases
Representative of eligible patients (e.g. population-based cancer registry)
Adequacy of case definition
Independent validation of outcome (blind to exposure status)
Controls
From same population as cases and same exclusion criteria used
Comparability of groups on demographic characteristics and important potential confounders
Comparable (or matched)
Ascertainment of exposure/treatment
No or not described
Follow-up complete and all patients included in the analysis?
Non-response unlikely to introduce bias (>80% in both cases and controls)
Size of effect
1 Reason for decision: large difference; clinically statistically relevant
Relevance of evidence
2 Additional comments: difference in HGD/cancer between definite LGD group and ND/ID group
Result of appraisal

Jutta's tick icon.png Included



Comments

although highly significant findings, the extremely low rate of LGD considered confirmed by reference pathologists raises question of generalisability. Also, the fact that initial follow-up scopes were done at non-expert centre raises question of whether worsening pathology is true progression or missed lesion initially.

Completed by

Dr Andrew Taylor MBBS MD FRACP


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


Article
Curvers WL, ten Kate FJ, Krishnadath KK, Visser M, Elzer B, Baak LC, et al. Low-grade dysplasia in Barrett's esophagus: overdiagnosed and underestimated. Am J Gastroenterol 2010 Jul;105(7):1523-30 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/20461069.
Assigned to
User:Andrew.taylor
Topic area
Guidelines:Barrett's
Clinical question
Form
Form:Critical appraisal


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