Ottawa Hospital Research Institute, Knowledge Synthesis Group, 501 Smyth Road, Ottawa, ON, Canada.
Department of Family Medicine, University of Ottawa, Ottawa, ON, Canada.
Syst Rev. 2020 Jan 29;9(1):20. doi: 10.1186/s13643-020-1275-2.
Two reviews and an overview were produced for the Canadian Task Force on Preventive Health Care guideline on screening for esophageal adenocarcinoma in patients with chronic gastroesophageal reflux disease (GERD) without alarm symptoms. The goal was to systematically review three key questions (KQs): (1) The effectiveness of screening for these conditions; (2) How adults with chronic GERD weigh the benefits and harms of screening, and what factors contribute to their preferences and decision to undergo screening; and (3) Treatment options for Barrett's esophagus (BE), dysplasia or stage 1 EAC (overview of reviews).
Bibliographic databases (e.g. Ovid MEDLINE®) were searched for each review in October 2018. We also searched for unpublished literature (e.g. relevant websites). The liberal accelerated approach was used for title and abstract screening. Two reviewers independently screened full-text articles. Data extraction and risk of bias assessments were completed by one reviewer and verified by another reviewer (KQ1 and 2). Quality assessments were completed by two reviewers independently in duplicate (KQ3). Disagreements were resolved through discussion. We used various risk of bias tools suitable for study design. The GRADE framework was used for rating the certainty of the evidence.
Ten studies evaluated the effectiveness of screening. One retrospective study reported no difference in long-term survival (approximately 6 to 12 years) between those who had a prior esophagogastroduodenoscopy and those who had not (adjusted HR 0.93, 95% confidence interval (CI) 0.58-1.50). Though there may be higher odds of a stage 1 diagnosis than a more advanced diagnosis (stage 2-4) if an EGD had been performed in the previous 5 years (OR 2.27, 95% CI 1.00-7.67). Seven studies compared different screening modalities, and showed little difference between modalities. Three studies reported on patients' unwillingness to be screened (e.g. due to anxiety, fear of gagging). Eleven systematic reviews evaluated treatment modalities, providing some evidence of early treatment effect for some outcomes.
Little evidence exists on the effectiveness of screening and values and preferences to screening. Many treatment modalities have been evaluated, but studies are small. Overall, there is uncertainty in understanding the effectiveness of screening and early treatments.
PROSPERO (CRD42017049993 [KQ1], CRD42017050014 [KQ2], CRD42018084825 [KQ3]).
加拿大预防保健工作组针对慢性胃食管反流病（GERD）无报警症状的患者进行食管腺癌筛查制定了两份综述和一份概述。目的是系统地审查三个关键问题（KQ）：（1）这些情况的筛查效果；（2）患有慢性 GERD 的成年人如何权衡筛查的利弊，以及哪些因素促成了他们的偏好和进行筛查的决定；（3）巴雷特食管（BE）、异型增生或 1 期 EAC（综述的综述）的治疗选择。
2018 年 10 月，我们对每篇综述的书目数据库（如 Ovid MEDLINE®）进行了检索。我们还检索了未发表的文献（如相关网站）。使用自由加速方法对标题和摘要进行筛选。两名审查员独立筛选全文文章。数据提取和偏倚风险评估由一名审查员完成，另一名审查员进行验证（KQ1 和 2）。两名审查员独立重复进行质量评估（KQ3）。通过讨论解决分歧。我们使用了各种适合研究设计的偏倚风险工具。使用 GRADE 框架对证据的确定性进行分级。
有 10 项研究评估了筛查的效果。一项回顾性研究报告称，在有或没有先前进行过食管胃十二指肠镜检查的患者中，长期生存（约 6 至 12 年）没有差异（调整后的 HR 0.93，95%置信区间（CI）0.58-1.50）。尽管如果在过去 5 年内进行了 EGD，可能会有更高的几率诊断为 1 期（OR 2.27，95%CI 1.00-7.67），而不是更晚期的诊断（2-4 期）。有 7 项研究比较了不同的筛查方法，结果显示方法之间差异不大。有 3 项研究报告了患者不愿意接受筛查（例如，由于焦虑、害怕窒息）。11 项系统综述评估了治疗方法，为某些结局的早期治疗效果提供了一些证据。
关于筛查的有效性以及对筛查的价值观和偏好的证据很少。已经评估了许多治疗方法，但研究规模较小。总体而言，对于理解筛查和早期治疗的有效性存在不确定性。
PROSPERO（CRD42017049993[KQ1]，CRD42017050014[KQ2]，CRD42018084825[KQ3]）。
