Critical appraisal:Wu J, Pan YM, Wang TT, Gao DJ, Hu B 2013 2

Critical Appraisal

Article being appraised

Wu J, Pan YM, Wang TT, Gao DJ, Hu B. Endotherapy versus surgery for early neoplasia in Barrett's esophagus: a meta-analysis. Gastrointest Endosc 2013 Sep 27 Available from: http://www.ncbi.nlm.nih.gov/pubmed/24079410.

Applicable clinical question

How effective is endoscopic management compared with surgical management for high grade dysplasia in patients with BO?

Key Facts

Study Design

systematic review — only no randomised studies as no randomised data

Number of Patients:

870

Evidence ratings

Level of evidence

III-2

Risk of bias

Moderate risk of bias

Comments: meta anlaysis of 7 non randomised trials comparing endotherapy with surg. No breakdown of HGD versus T1a, variety of enod treatments used with limited RFA use.

Show/Hide Risk of bias assessment

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?

Yes – pre-specified inclusion criteria applied independently by two people

Were the studies assessed for quality (relating to the minimisation of biases)?

Yes – appropriate quality issues were assessed independently by two people

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?

Yes

If there was heterogeneity, were sources of heterogeneity explored?

Some attempt was made

Size of effect

2	Reason for decision: only diference in recurrence rate with rr of 9.5 with ci of 3.26-27.75, and fewer major adverse events rr 0.38 ci 0.2-0.73

Relevance of evidence

1	Additional comments: reports cnasre free survival and overall survival, info on morbidity and mortality, no difference, slightly higher recurrence rate in endo grooup but no effect on survival and most treated with endo therapy. Groups not similar

Result of appraisal

Included