Visrodia Kavel, Singh Siddharth, Krishnamoorthi Rajesh, Ahlquist David A, Wang Kenneth K, Iyer Prasad G, Katzka David A
Division of Gastroenterology and Hepatology, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota.
Division of Gastroenterology and Hepatology, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota; Division of Gastroenterology, University of California-San Diego, La Jolla, California; Division of Biomedical Informatics, University of California-San Diego, La Jolla, California.
Gastroenterology. 2016 Mar;150(3):599-607.e7; quiz e14-5. doi: 10.1053/j.gastro.2015.11.040. Epub 2015 Nov 24.
BACKGROUND & AIMS: A proportion of patients with Barrett's esophagus (BE) are diagnosed with esophageal adenocarcinoma (EAC) within 1 year of an endoscopic examination that produced negative findings. These cases of missed cancers have not been well studied, despite current surveillance strategies for BE. We performed a systematic review and meta-analysis to determine the magnitude of missed EAC in cohorts of patients with BE.
We searched MEDLINE, EMBASE, and Web of Science from their inception to May 31, 2015 to identify cohort studies of adults with BE (baseline nondysplastic BE ± BE with low-grade dysplasia) and at least a 3-year follow-up period, providing data on missed and incident EACs (diagnosed within 1 year and diagnosed more than 1 year after the initial endoscopy in which BE was diagnosed, respectively). The main outcome measure was pooled proportion of missed and incident EACs (of all EACs detected after initial endoscopy) among BE cohorts, using a random effects model.
In a meta-analysis of 24 studies reporting on 820 missed and incident EACs, 25.3% were classified as missed (95% confidence interval: 16.4%-36.8%) and 74.7% as incident EACs (95% CI: 63.2%-83.6%), although there was substantial heterogeneity among studies (I2 = 74%). When the analysis was restricted to nondysplastic BE cohorts (15 studies), 23.9% of EACs were classified as missed (95% confidence interval: 15.3%-35.4%; I2 = 0%). In a meta-analysis of 10 studies with follow-up periods of ≥5 years (a total of 239 EACs), 22.0% were classified as missed (95% confidence interval: 8.7%-45.5%), with substantial heterogeneity (I2 = 68%).
Among adults with nondysplastic BE (or BE with low-grade dysplasia) at their index endoscopy and at least a 3-year follow-up period, 25% of EACs are diagnosed within 1 year after the index endoscopy. Additional resources should be allocated to detect missed EAC.
一部分巴雷特食管（BE）患者在内镜检查结果为阴性后的1年内被诊断出食管腺癌（EAC）。尽管目前有针对BE的监测策略，但这些漏诊癌症的病例尚未得到充分研究。我们进行了一项系统评价和荟萃分析，以确定BE患者队列中漏诊EAC的比例。
我们检索了MEDLINE、EMBASE和Web of Science数据库，检索时间从建库至2015年5月31日，以确定关于成人BE（基线无发育异常的BE±伴有低级别发育异常的BE）且随访期至少为3年的队列研究，这些研究需提供漏诊和新发EAC的数据（分别为在诊断BE的初次内镜检查后1年内诊断出的和初次内镜检查后1年以上诊断出的）。主要结局指标是使用随机效应模型汇总BE队列中漏诊和新发EAC（在初次内镜检查后检测到的所有EAC中）的比例。
在一项对24项报告了820例漏诊和新发EAC的研究进行的荟萃分析中，25.3%被归类为漏诊（95%置信区间：16.4%-36.8%），74.7%为新发EAC（95%CI：63.2%-83.6%），尽管各研究之间存在显著异质性（I²=74%）。当分析仅限于无发育异常的BE队列（15项研究）时，23.9%的EAC被归类为漏诊（95%置信区间：15.3%-35.4%；I²=0%）。在一项对随访期≥5年的10项研究（共239例EAC）进行的荟萃分析中，22.0%被归类为漏诊（95%置信区间：8.7%-45.5%），存在显著异质性（I²=68%）。
在内镜检查时为无发育异常的BE（或伴有低级别发育异常的BE）且随访期至少为3年的成年人中，25%的EAC在初次内镜检查后的1年内被诊断出来。应分配更多资源以检测漏诊的EAC。
