Critical appraisal:Ramus JR, Gatenby PA, Caygill CP, Winslet MC, Watson A 2009

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Critical Appraisal

Article being appraised

Ramus JR, Gatenby PA, Caygill CP, Winslet MC, Watson A. Surveillance of Barrett's columnar-lined oesophagus in the UK: endoscopic intervals and frequency of detection of dysplasia. Eur J Gastroenterol Hepatol 2009 Jun;21(6):636-41 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/19177028.


Applicable clinical question

Key Facts

Study Design

cohort study

Number of Patients:

818


Includes an economic evaluation

no

Evidence ratings

Level of evidence

II

Risk of bias
High risk of bias Comments: Large prospective multicentre UK cohort study of surveillance in Barrett's. Non-standardized surveillance endoscopy and biopsy protocol. No follow up of those diagnosed with Barrett's oesophagus but who didn't enter surveillance protocol.Aim to examine surveillance practice for Barrett's in the UK and impact of endoscopic intervals on detection of dysplastic disease.

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
1 Reason for decision: Significant variation in frequency of surveillance in lowgrade dysplasia but not nondysplasia or high grade dypslasia. No relationship between frequency of detection of dysplasia and endoscopic frequency in surveillance of uncomplicated Barrett's (p=0.391). No relationship found between frequency of cancer detection and frequency of endoscopy for high grade dysplasia surveillance (p=0.299). In low grade dysplasia surveillance there were significantly higher proportions of High grade/cancer detected at endoscopy intervals of 3 monthly or less (p =0.013). However, this may of been confounded by an association between macroscopic disease and increased frequency of endoscopic surveillance in those with low grade dysplasia.
Relevance of evidence
1 Additional comments: Examined if frequency of endoscopic surveillance was associated with an increased detection of high grade dysplasia and cancer.
Result of appraisal

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Completed by

Dr Bradley Kendall MBBS, FRACP


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


Article
Ramus JR, Gatenby PA, Caygill CP, Winslet MC, Watson A. Surveillance of Barrett's columnar-lined oesophagus in the UK: endoscopic intervals and frequency of detection of dysplasia. Eur J Gastroenterol Hepatol 2009 Jun;21(6):636-41 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/19177028.
Assigned to
User:Brad.kendall
Topic area
Guidelines:Barrett's
Clinical question
Form
Form:Critical appraisal


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