Critical appraisal:Sánchez A, Reza M, Blasco JA, Callejo D 2010 4

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Critical Appraisal

Article being appraised

Sánchez A, Reza M, Blasco JA, Callejo D. Effectiveness, safety, and cost-effectiveness of photodynamic therapy in Barrett's esophagus: a systematic review. Dis Esophagus 2010 Nov;23(8):633-40 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/20545970.


Applicable clinical question

Key Facts

Study Design

systematic review — The review includes studies examining the use of PDT in the treatment of Barrett's oesophagus. Randomised clinical trials involving humans were included that looked at either treatment of Barrett's oesophagus or cost efficacy. Duplicated, foreign language studies and uncontrolled studies were excluded. Combination therapies or evaluation of new techniques were not included.

Number of Patients:

Not applicable


Includes an economic evaluation

yes

Evidence ratings

Level of evidence

I

Risk of bias
High risk of bias Comments: There was no attempt to combine any of the data or apply any form of statistical assessment. The paper was purely descriptive of the literature. There were significant variations in the methods of the studies including significant differences in the photosensitisers used. In 4 of the included 12 papers, the photosensitiser was not stated. Patient inclusion varied from dysplastic Barrett's through to groups without dysplasia and the length of treated Barrett's also varied significantly. Finally the PDT was compared to a variety of "control" groups including those treated with APC, oesophagectomy, placebo, endoscopic follow up or NO follow up. The summary of cost efficacy showed huge variation in costs making interpretation relatively uncertain.

Risk of bias assessment: systematic review

Studies included in the review
Was an adequate search strategy used?
Very thorough – included appropriate search terms and databases
Were the inclusion criteria appropriate and applied in an unbiased way?
No – inclusion was decided in an arbitrary fashion or not described
Were the studies assessed for quality (relating to the minimisation of biases)?
Adequate – some problems with quality issues or assessed by one person only
Were the characteristics and results of individual studies appropriately summarised?
Adequate – more information would be desirable
The following questions are only relevant for systematic reviews that pooled data
Were the methods used for pooling the data appropriate?
No response
If there was heterogeneity, were sources of heterogeneity explored?
No response
Size of effect
5 Reason for decision: The included studies show significant heterogeneity of included patients. Most studies where quoted had low numbers of patients. No statistical methods were applied in this paper.
Relevance of evidence
2 Additional comments: The reviewed literature consistently showed that PDT was able to effective ablate Barrett's oesophagus
Result of appraisal

Jutta's tick icon.png Included



Comments

I have included the paper as it does summarise the clinical experience in using PDT in the treatment of Barrett's oesophagus. The end points are weak but the value of the paper is that it clearly shows that PDT can ablate Barrett's mucosa. The side effects and complications of this therapy received scant attention.

Completed by

Dr Mark Schoeman MBBS, PhD, FRACP, AGAF


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


Article
Sánchez A, Reza M, Blasco JA, Callejo D. Effectiveness, safety, and cost-effectiveness of photodynamic therapy in Barrett's esophagus: a systematic review. Dis Esophagus 2010 Nov;23(8):633-40 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/20545970.
Assigned to
User:Mark.schoeman
Topic area
Guidelines:Barrett's
Clinical question
Form
Form:Critical appraisal


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