Critical appraisal:Pech O, Bollschweiler E, Manner H, Leers J, Ell C, Hölscher AH 2011

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Article
Pech O, Bollschweiler E, Manner H, Leers J, Ell C, Hölscher AH. Comparison between endoscopic and surgical resection of mucosal esophageal adenocarcinoma in Barrett's esophagus at two high-volume centers. Ann Surg 2011 Jul;254(1):67-72 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/21532466.
Assigned to
User:Bernard.smithers
Topic area
Guidelines:Barrett's
Clinical question
Form
Form:Critical appraisal


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Critical Appraisal

Article being appraised

Pech O, Bollschweiler E, Manner H, Leers J, Ell C, Hölscher AH. Comparison between endoscopic and surgical resection of mucosal esophageal adenocarcinoma in Barrett's esophagus at two high-volume centers. Ann Surg 2011 Jul;254(1):67-72 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/21532466.


Applicable clinical question

Key Facts

Study Design

cohort study

Number of Patients:

114


Includes an economic evaluation

no

Evidence ratings

Level of evidence

III-2

Risk of bias
High risk of bias Comments: This article related to early adenocarcinoma removed by EMR and then ablation of the Barrett's with APC. The article is relevant if early adenoca - intramucosal ca is used as a surrogate for HGD given ablation was applied. The assessment of cancer mortality would not be relevant to HGD but complete ablation and morbidity of the two procedures is relevant.

Complete remission with follow up over 3 years was 98.7% for ET and 100% for surgery. Complication rate higher for surgery (32% v 0) as was mortality of the procedure. 2.6% vs 0)

Risk of bias assessment: cohort study

Subject selection
"New technology" group
Selected group
Comparison group
Selected group
Comparability of groups on demographic characteristics and clinical features
Not comparable but adjusted analysis used
Measurement of outcomes
Outcome measures blind to technology used
No, but objective measures used
Same method of measurement used across comparison groups
No or not described
Completeness of follow-up
Was follow-up complete and were all patients included in the analysis?
Yes (follow-up >95%) or survival analysis using all patients
Size of effect
2 Reason for decision: No CI in stats but difference in primary outcomes of morbidity and simailr Barrett's eradication rate significant.
Relevance of evidence
2 Additional comments: Using Intramucosal ca in Barrett's as a surrogate for HGD
Result of appraisal

Jutta's tick icon.png Included




Completed by

Associate Professor Bernard Mark Smithers