The Effect of Endoscopic Surveillance in Patients With Barrett's Esophagus: A Systematic Review and Meta-analysis.
The Effect of Endoscopic Surveillance in Patients With Barrett's Esophagus: A Systematic Review and Meta-analysis.
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DOI：
10.1053/j.gastro.2018.02.022
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发表时间：
2018-06
期刊：
影响因子：
29.4
通讯作者：
Iyer PG
中科院分区：
文献类型：
--
作者：
Codipilly DC;Chandar AK;Singh S;Wani S;Shaheen NJ;Inadomi JM;Chak A;Iyer PG
指南建议对巴雷特食管（BE）患者进行内镜监测，以确定那些患有不典型增生（癌的前兆）或早期食管腺癌（EAC）的患者，这些患者可以进行内镜治疗。然而，尚不清楚监测是否会增加BE患者的生存时间。我们进行了系统回顾和荟萃分析，以定性和定量地检验内窥镜监测与BE患者生存和其他结果的关联证据。我们检索了出版物数据库，以报告内镜监测对死亡率和其他eac相关结果的影响。我们回顾了随机对照试验、病例对照研究、比较接受定期监测的BE患者与未接受定期监测的患者的研究，以及比较监测检测到的EAC患者与症状检测到的EACs患者结局的研究。我们对监测研究进行了荟萃分析，使用随机效应模型生成汇总估计。主要目的是研究BE监测与eac相关死亡率的关系。次要目的是研究BE监测与诊断时全因死亡率和EAC分期的关系。一项病例对照研究未显示监测与eac相关死亡率之间的任何关联。4项队列研究的荟萃分析发现，定期监测与较低的eac相关和全因死亡率相关（相对危险度0.60;95% CI 0.50-0.71；风险比0.75;95% CI 0.59-0.94）。12项队列研究的荟萃分析显示，监测检测到EAC的患者与症状检测到EAC的患者相比，EAC相关的全因死亡率更低（相对危险度为0.73；95% CI为0.57-0.94；风险比为0.59；95% CI为0.45-0.76）。引线和长时间偏置调整大大减弱/消除了观察到的好处。监测与早期发现EAC有关。一项随机试验正在进行中，以评估内镜监测对BE患者死亡率的影响。在一项对BE患者监测效果的系统回顾和荟萃分析中，目前进行的监测与早期EAC的检测有关，并可能提供少量的生存益处。然而，混杂偏倚对这些估计的影响尚未完全定义，可能完全或部分解释了调查和未调查患者之间观察到的差异。
Guidelines recommend endoscopic surveillance of patients with Barrett’s esophagus (BE) to identify those with dysplasia (a precursor of carcinoma) or early-stage esophageal adenocarcinoma (EAC), who can be treated endoscopically. However, it is unclear whether surveillance increases survival times of patients with BE. We performed a systematic review and meta-analysis to qualitatively and quantitatively examine evidence for the association of endoscopic surveillance in patients with BE with survival and other outcomes. We searched publication databases for studies reporting the effects of endoscopic surveillance on mortality and other EAC-related outcomes. We reviewed randomized controlled trials, case–control studies, studies comparing patients with BE who received regular surveillance to those who did not receive regular surveillance, as well as studies comparing outcomes of patients with surveillance-detected EAC vs. symptom-detected EACs. We performed a meta-analysis of surveillance studies to generate summary estimates using a random effects model. The primary aim was to examine the association of BE surveillance on EAC-related mortality. Secondary aims were to examine the association of BE surveillance with all-cause mortality and EAC stage at time of diagnosis. A single case-control study did not reveal any association between surveillance and EAC-related mortality. A meta-analysis of 4 cohort studies found lower EAC-related and all-cause mortality associated with regular surveillance (relative risk, 0.60; 95% CI, 0.50–0.71 and hazard ratio, 0.75; 95% CI, 0.59–0.94). Meta-analysis of 12 cohort studies demonstrated lower EAC-related and all-cause mortality among patients with surveillance-detected EAC vs. symptom-detected EAC (relative risk, 0.73; 95% CI, 0.57–0.94 and hazard ratio, 0.59; 95% CI, 0.45–0.76). Lead- and length-time bias adjustment substantially attenuated/eliminated the observed benefits. Surveillance was associated with detection of EAC at earlier stages. A randomized trial is underway to evaluate the effects of endoscopic surveillance on mortality in patients with BE. In a systematic review and meta-analysis of the effects of surveillance in patients with BE, surveillance as currently performed was associated with detection of earlier stage EAC and may provide a small survival benefit. However, the effects of confounding biases on these estimates are not fully defined, and may completely or partially explain the observed differences between surveyed and unsurveyed patients.
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影响因子：
24.5
作者：
Kastelein, F.;van Olphen, S. H.;Bruno, M. J.
通讯作者：
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DOI：
10.1016/j.bpg.2014.11.007
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作者：
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通讯作者：
de Caestecker, John