Critical appraisal:Nigro JJ, Hagen JA, DeMeester TR, DeMeester SR, Theisen J, Peters JH, et al 1999

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Critical Appraisal

Article being appraised

Nigro JJ, Hagen JA, DeMeester TR, DeMeester SR, Theisen J, Peters JH, et al. Occult esophageal adenocarcinoma: extent of disease and implications for effective therapy. Ann Surg 1999 Sep;230(3):433-8; discussion 438-40 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/10493489.


Applicable clinical question

Key Facts

Study Design

case series

Number of Patients:

33


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 is a retrospective single-centre series of 33 patients with HGD or adenocarcinoma with no endoscopically visible lesion that underwent systematic biopsies followed by oesophagectomy. The findings were compared with 12 patients with endoscopically visible lesions. The results showed a biopsy error rate for detecting adenocarcinoma was 43%. Of 25 patients with cancer and no visible lesion, the cancer was limited to the mucosa in 22 (88%) and to the submucosa in 3 (12%). After en bloc oesophagectomy, one patient without a visible lesion had a single node metastasis on conventional histology. The 5-year survival rate after oesophagectomy was 90%. Patients with endoscopically visible lesions were significantly more likely to have invasion beyond the mucosa (p=0.01) and involvement of lymph nodes (p=0.057). The authors concluded that endoscopy with systematic biopsy cannot reliably exclude the presence of occult adenocarcinoma in Barrett's esophagus.

Completed by

Dr Jeremy Dwyer MBBS (Hons)


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Article
Nigro JJ, Hagen JA, DeMeester TR, DeMeester SR, Theisen J, Peters JH, et al. Occult esophageal adenocarcinoma: extent of disease and implications for effective therapy. Ann Surg 1999 Sep;230(3):433-8; discussion 438-40 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/10493489.
Assigned to
User:Alan.moss
Topic area
Guidelines:Barrett's
Clinical question
Form
Form:Critical appraisal


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