Critical appraisal:Reid BJ, Levine DS, Longton G, Blount PL, Rabinovitch PS 2000

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Critical Appraisal

Article being appraised

Reid BJ, Levine DS, Longton G, Blount PL, Rabinovitch PS. Predictors of progression to cancer in Barrett's esophagus: baseline histology and flow cytometry identify low- and high-risk patient subsets. Am J Gastroenterol 2000 Jul;95(7):1669-76 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/10925966.


Applicable clinical question

Key Facts

Study Design

cohort study

Number of Patients:

327


Includes an economic evaluation

no

Evidence ratings

Level of evidence

II

Risk of bias
High risk of bias Comments: Large prospective cohort of patients in a surveillance programme at a single centre in US. Standardized surveillance endoscopy and biopsy protocol but information regarding adherence to biopsy protocols not reported. Main aim of the study was to evaluate if baseline histological and cytometric abnormalities predicted risk of subsequent oesophageal adenocarcinoma. No adjustment was made in the analysis for other potential confounders including smake, age, sex, BMI.

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: The study found that those with high grade dysplasia (RR 28 ; 95%CI 13-63), aneuploidy (RR 11 ; 95%CI 5.5-21)and increased 4N (RR 5 ; 95%CI 2.7-9.4) at baseline had a significantly higher rate of progression to oesophageal adenocarcinoma than those with no/indefinite/low grade dyplsasia and no aneuploidy/increased 4N.
Relevance of evidence
1 Additional comments: Study looks at development of patient relevant outcome (cancer).
Result of appraisal

Jutta's tick icon.png Included




Completed by

Dr Bradley Kendall MBBS, FRACP


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


Article
Reid BJ, Levine DS, Longton G, Blount PL, Rabinovitch PS. Predictors of progression to cancer in Barrett's esophagus: baseline histology and flow cytometry identify low- and high-risk patient subsets. Am J Gastroenterol 2000 Jul;95(7):1669-76 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/10925966.
Assigned to
User:Brad.kendall
Topic area
Guidelines:Barrett's
Clinical question
Form
Form:Critical appraisal


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