Critical appraisal:Dyer SM, Levison DB, Chen RY, Lord SJ, Blamey S 2008

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Critical Appraisal

Article being appraised

Dyer SM, Levison DB, Chen RY, Lord SJ, Blamey S. Systematic review of the impact of endoscopic ultrasound on the management of patients with esophageal cancer. Int J Technol Assess Health Care 2008;24(1):25-35 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/18218166.


Applicable clinical question

Key Facts

Study Design

systematic review — The systematic review included a variety of study designs including (1) comparative studies reporting survival following EUS esophageal cancer staging and (2) therapeutic impact studies reporting change in patient management following EUS.

Number of Patients:

1328


Includes an economic evaluation

no

Evidence ratings

Level of evidence

IV

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

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?
No response
If there was heterogeneity, were sources of heterogeneity explored?
No response
Size of effect
5 Reason for decision: Please replace this text and briefly describe the reasons for your rating
Relevance of evidence
1 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 systematic review included studies that were comparative studies reporting survival
following EUS esophageal cancer staging or therapeutic impact studies reporting
change in patient management following EUS. One systematic review, five studies reporting therapeutic impact, and two studies reporting patient survival were identified. Management changed in 24–29 percent of patients following EUS staging of esophageal cancer (two studies). One retrospective cohort study with historical control found
EUS staging of esophageal cancer improved patient survival; a second study did not find a survival benefit for EUS staging in patients undergoing resection.

Completed by

Dr Jeremy Dwyer MBBS (Hons)


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


Article
Dyer SM, Levison DB, Chen RY, Lord SJ, Blamey S. Systematic review of the impact of endoscopic ultrasound on the management of patients with esophageal cancer. Int J Technol Assess Health Care 2008;24(1):25-35 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/18218166.
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

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