Bashar J Qumseya1, Jessica Brown2, Merna Abraham1, Donna White3, Herbert Wolfsen1, Neil Gupta4, Prashanth Vennalaganti3, Prateek Sharma3, Michael B Wallace1. 1. Division of Gastroenterology and Hepatology at Mayo Clinic, Jacksonville, Florida, USA. 2. Division of Gastroenterology and Hepatology, Veterans Affairs Medical Center and University of Kansas Medical Center, Kansas City, Missouri, USA. 3. Sections of Health Services Research & Gastroenterology and Hepatology, Baylor College of Medicine and Michael E. DeBakey VA, Houston, Texas, USA. 4. Loyola University Health System, Maywood, Illinois, USA.
Abstract
BACKGROUND: The role of EUS among patients with Barrett's esophagus (BE) with high-grade dysplasia (HGD) or suspected mucosal carcinoma is controversial. OBJECTIVE: To define the role of EUS in detecting advanced disease among patients with BE. DESIGN: Systematic review and meta-analysis. SETTING: MEDLINE, Embase, Web of Science, and Cochrane Central databases. PATIENTS: Patients with BE and HGD or esophageal adenocarcinoma (EAC) who were referred for endoscopic evaluation and underwent EUS. INTERVENTIONS: EUS. MAIN OUTCOME MEASUREMENTS: Pooled proportion of patients with advanced EAC identified by EUS among patients with BE who are referred for HGD or EAC (with or without visible lesions). Forest plots were used to contrast effect sizes in each of the studies and random effect models when tests of heterogeneity were significant (I(2) > 50% or P < .1 for the Q statistic). RESULTS: Of 1278 articles, 47 were reviewed in full text, and 11 articles met the inclusion criteria, including a total of 656 patients. Based on a random-effects model, the proportion of patients with advanced disease detected on EUS was 14% (95% confidence interval, 8%-22%; P < .0001). In a subanalysis, the pooled proportion of patients with advanced disease on EUS in the absence of nodules was 4% (95% confidence interval, 2%-6%, P < .0001). LIMITATIONS: Significant heterogeneity among studies. CONCLUSIONS: EUS will result in a change in the therapeutic approach among in a significant minority of patients with BE who are referred for HGD or EAC.
BACKGROUND: The role of EUS among patients with Barrett's esophagus (BE) with high-grade dysplasia (HGD) or suspected mucosal carcinoma is controversial. OBJECTIVE: To define the role of EUS in detecting advanced disease among patients with BE. DESIGN: Systematic review and meta-analysis. SETTING: MEDLINE, Embase, Web of Science, and Cochrane Central databases. PATIENTS: Patients with BE and HGD or esophageal adenocarcinoma (EAC) who were referred for endoscopic evaluation and underwent EUS. INTERVENTIONS: EUS. MAIN OUTCOME MEASUREMENTS: Pooled proportion of patients with advanced EAC identified by EUS among patients with BE who are referred for HGD or EAC (with or without visible lesions). Forest plots were used to contrast effect sizes in each of the studies and random effect models when tests of heterogeneity were significant (I(2) > 50% or P < .1 for the Q statistic). RESULTS: Of 1278 articles, 47 were reviewed in full text, and 11 articles met the inclusion criteria, including a total of 656 patients. Based on a random-effects model, the proportion of patients with advanced disease detected on EUS was 14% (95% confidence interval, 8%-22%; P < .0001). In a subanalysis, the pooled proportion of patients with advanced disease on EUS in the absence of nodules was 4% (95% confidence interval, 2%-6%, P < .0001). LIMITATIONS: Significant heterogeneity among studies. CONCLUSIONS: EUS will result in a change in the therapeutic approach among in a significant minority of patients with BE who are referred for HGD or EAC.
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Authors: Durayd Alzoubaidi; Krish Ragunath; Sachin Wani; Ian D Penman; Nigel John Trudgill; Marnix Jansen; Matthew Banks; Pradeep Bhandari; Allan John Morris; Robert Willert; Phil Boger; Howard L Smart; Narayanasamy Ravi; Jason Dunn; Charles Gordon; Jayan Mannath; Inder Mainie; Massi di Pietro; Andrew M Veitch; Sally Thorpe; Cormac Magee; Martin Everson; Sarmed Sami; Paul Bassett; David Graham; Stephen Attwood; Oliver Pech; Prateek Sharma; Laurence B Lovat; Rehan Haidry Journal: Frontline Gastroenterol Date: 2019-08-14
Authors: Michele Valmasoni; Elisa Sefora Pierobon; Alberto Ruol; Carlo Alberto De Pasqual; Gianpietro Zanchettin; Lucia Moletta; Renato Salvador; Mario Costantini; Stefano Merigliano Journal: PLoS One Date: 2016-04-18 Impact factor: 3.240