Critical appraisal:Prasad GA, Wang KK, Buttar NS, Wongkeesong LM, Krishnadath KK, Nichols FC 3rd, et al 2007 2

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Critical Appraisal

Article being appraised

Prasad GA, Wang KK, Buttar NS, Wongkeesong LM, Krishnadath KK, Nichols FC 3rd, et al. Long-term survival following endoscopic and surgical treatment of high-grade dysplasia in Barrett's esophagus. Gastroenterology 2007 Apr;132(4):1226-33 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/17408660.


Applicable clinical question

Key Facts

Study Design

cohort study

Number of Patients:

199


Includes an economic evaluation

no

Evidence ratings

Level of evidence

III-2

Risk of bias
High risk of bias Comments: cohort study single institution over 10 years, main outcome is overall survival and no difference found, non significant difference in cancer free survival between groups. Retrosepective and patients highly selected.

Overall mortality 9% endo vs 8.5% surg, good follow up 60/12 Comments on success of endo to clear HGD, 33/129 failed to clear hgd within 1 year of these 10 failed to clear with more treatment. 8 cases of cancer in endo group of which 7 had surg & 1 EMR fro ti disease. ( csaes of T1 cancer in surg group. No comment on barretts eradication.

Risk of bias assessment: cohort study

Subject selection
"New technology" group
Highly selected or not described
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
4 Reason for decision: overall survival no difference but cancer free survival p=0.6 no confidence intervals and data not well explained, possible that endoscopic treatment decreases chance of cancer free survival.
Relevance of evidence
1 Additional comments: Overall survival relevant, no difference seen
Result of appraisal

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Completed by

Associate Professor Bernard Mark Smithers


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Article
Prasad GA, Wang KK, Buttar NS, Wongkeesong LM, Krishnadath KK, Nichols FC 3rd, et al. Long-term survival following endoscopic and surgical treatment of high-grade dysplasia in Barrett's esophagus. Gastroenterology 2007 Apr;132(4):1226-33 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/17408660.
Assigned to
User:Bernard.smithers
Topic area
Guidelines:Barrett's
Clinical question
Form
Form:Critical appraisal


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