Critical appraisal:Pacifico RJ, Wang KK, Wongkeesong LM, Buttar NS, Lutzke LS 2003

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Critical Appraisal

Article being appraised

Pacifico RJ, Wang KK, Wongkeesong LM, Buttar NS, Lutzke LS. Combined endoscopic mucosal resection and photodynamic therapy versus esophagectomy for management of early adenocarcinoma in Barrett's esophagus. Clin Gastroenterol Hepatol 2003 Jul;1(4):252-7 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/15017665.


Applicable clinical question

Key Facts

Study Design

cohort study

Number of Patients:

88


Includes an economic evaluation

no

Evidence ratings

Level of evidence

III-2

Risk of bias
High risk of bias Comments: historical cohort comparing all t1 cancers over 6 years either surg or emr/pdt. No any HGD therfore prbabaly not applicable specifically to question, n=but is a comparison of surg to endo.

Results - 4/24 (17%) endo had recurrent ca and had either surg, crt 2 dead other causes morbidity higher in surg group 31 (48%) vs 4 (17%) , mortality surg 2/84 vs 0/24 short folow up

Risk of bias assessment: cohort study

Subject selection
"New technology" group
No response
Comparison group
No response
Comparability of groups on demographic characteristics and clinical features
No response
Measurement of outcomes
Outcome measures blind to technology used
No response
Same method of measurement used across comparison groups
No response
Completeness of follow-up
Was follow-up complete and were all patients included in the analysis?
No response
Size of effect
5 Reason for decision: no stats on comparison on clearing cancer, p=0.01 on all morbidity
Relevance of evidence
1 Additional comments: 17% failure rate in clearing adenocarcinoma in endo group vs 0% in surg. Morbidity higher in surg group 48% versus 17% in endo
Result of appraisal

Jutta's exclamation mark icon.png Excluded

Reason for decision

No patients with HGD in the cohorts, despite comparing endoscopic treatment with surgical cohort over same period.


Completed by

Associate Professor Bernard Mark Smithers


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


Article
Pacifico RJ, Wang KK, Wongkeesong LM, Buttar NS, Lutzke LS. Combined endoscopic mucosal resection and photodynamic therapy versus esophagectomy for management of early adenocarcinoma in Barrett's esophagus. Clin Gastroenterol Hepatol 2003 Jul;1(4):252-7 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/15017665.
Assigned to
User:Bernard.smithers
Topic area
Guidelines:Barrett's
Clinical question
Form
Form:Critical appraisal


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