scholarly journals DIAGNOSIS, TREATMENT AND FOLLOW-UP OF BARRETT’S ESOPHAGUS: A SYSTEMATIC REVIEW

2020 ◽  
Vol 57 (3) ◽  
pp. 289-295
Author(s):  
José Roberto ALVES ◽  
Fabrissio Portelinha GRAFFUNDER ◽  
João Vitor Ternes RECH ◽  
Caique Martins Pereira TERNES ◽  
Iago KOERICH-SILVA
Keyword(s):  
Systematic Review ◽  
Randomized Controlled Trials ◽  
Barrett’S Esophagus ◽  
Barrett's Esophagus ◽  
Endoscopic Surveillance ◽  
Controlled Trials ◽  
Low Grade ◽  
Randomized Controlled ◽  
Mesh Terms

ABSTRACT BACKGROUND: Barrett’s esophagus (BE) is a premalignant condition that raises controversy among general practitioners and specialists, especially regarding its diagnosis, treatment, and follow-up protocols. OBJECTIVE: This systematic review aims to present the particularities and to clarify controversies related to the diagnosis, treatment and surveillance of BE. METHODS: A systematic review was conducted on PubMed, Cochrane, and SciELO based on articles published in the last 10 years. PRISMA guidelines were followed and the search was made using MeSH and non-MeSH terms “Barrett” and “diagnosis or treatment or therapy or surveillance”. We searched for complete randomized controlled clinical trials or Phase IV studies, carried out with individuals over 18 years old. RESULTS: A total of 42 randomized controlled trials were selected after applying all inclusion and exclusion criteria. A growing trend of alternative and safer techniques to traditional upper gastrointestinal endoscopy were identified, which could improve the detection of BE and patient acceptance. The use of chromoendoscopy-guided biopsy protocols significantly reduced the number of biopsies required to maintain similar BE detection rates. Furthermore, the value of BE chemoprophylaxis with esomeprazole and acetylsalicylic acid was relevant, as well as the establishment of protocols for the follow-up and endoscopic surveillance of patients with BE based predominantly on the presence and degree of dysplasia, as well as on the length of the follow-up affected by BE. CONCLUSION: Although further studies regarding the diagnosis, treatment and follow-up of BE are warranted, in light of the best evidence presented in the last decade, there is a trend towards electronic chromoendoscopy-guided biopsies for the diagnosis of BE, while treatment should encompass endoscopic techniques such as radiofrequency ablation. Risks of ablative endoscopic methods should be weighted against those of resective surgery. It is also important to consider lifetime endoscopic follow-up for both short and long term BE patients, with consideration to limitations imposed by a range of comorbidities. Unfortunately, there are no randomized controlled trials that have evaluated which is the best recommendation for BE follow-up and endoscopic surveillance (>1 cm) protocols, however, based on current International Guidelines, it is recommended esophagogastroduodenoscopy (EGD) every 5 years in BE without dysplasia with 1 up to 3 cm of extension; every 3 years in BE without dysplasia with >3 up to 10 cm of extension, every 6 to 12 months in BE with low grade dysplasia and, finally, EGD every 3 months after ablative endoscopic therapy in cases of BE with high grade dysplasia.

S1482: Endoscopic Interventions for Barrett's Esophagus With Low-Grade Dysplasia to Prevent Progression: A Meta-Analysis of Randomized Controlled Trials

2010 ◽  
Vol 71 (5) ◽  
pp. AB173-AB174 ◽  
Author(s):  
Abhishek Choudhary ◽  
Nicholas M. Szary ◽  
Vanessa K. Kuwajima ◽  
Murtaza Arif ◽  
Ghassan M. Hammoud ◽  
...  
Keyword(s):  
Randomized Controlled Trials ◽  
Barrett’S Esophagus ◽  
Barrett's Esophagus ◽  
Meta Analysis ◽  
Controlled Trials ◽  
Low Grade ◽  
Randomized Controlled ◽  
Low Grade Dysplasia

scholarly journals PubMed is Slightly More Sensitive but More Time Intensive to Search than Ovid MEDLINE

2011 ◽  
Vol 6 (2) ◽  
pp. 51
Author(s):  
Cari Merkley
Keyword(s):  
Rheumatoid Arthritis ◽  
Systematic Review ◽  
Randomized Controlled Trials ◽  
Controlled Trials ◽  
Medline Search ◽  
Search Results ◽  
Randomized Controlled ◽  
Ovid Medline ◽  
Mesh Terms ◽  
The University

Objective — To compare the results of searching the MEDLINE database through Ovid and the free online version of PubMed administered by the National Library of Medicine for randomized controlled trials on the subject of the drug methotrexate (MTX) for patients suffering from rheumatoid arthritis. Design — Comparative analysis of search results. Setting — Searches conducted by researchers affiliated with Mahidol University in Bangkok, Thailand, and the University of Toronto and the University Health Network in Toronto, Ontario. Subjects — A total of 3966 search results obtained from Ovid MEDLINE and PubMed. Methods — This study employs an Ovid MEDLINE search strategy originally created for a published systematic review that identified randomized controlled trials on MTX and rheumatoid arthritis (Katchamart, Trudeau, Phumethum, & Bombardier, 2009). Two of the authors of the original systematic review (Katchamart and Bombardier) are among the authors of this current study. Appropriate medical subject heading (MeSH) terms and their synonyms were identified for the three main concepts (rheumatoid arthritis, MTX, and randomized controlled trials). The search was performed in Ovid MEDLINE, seeking articles in any language that met the search criteria, from the earliest date covered by MEDLINE to January 2009. Each MeSH or keyword term within a concept was searched separately, and then combined with other like terms using the Boolean operator OR. The searches for the three concepts were finally combined using AND. The Ovid MEDLINE search was then translated for use in PubMed by an information professional. The formatting and terminology used in some of the original Ovid MEDLINE search statements had to be changed so they would work in the new database environment, but the researchers tried to ensure that the two searches were as similar as possible. The translated search was then executed in PubMed. The final results, as well as the number of articles retrieved for each key search concept (rheumatoid arthritis, MTX, and randomized controlled trials), were then compared. The final results were further analyzed for measures of sensitivity, precision, and number needed to read. Sensitivity is calculated by the number of eligible studies found in a database divided by the “total number of eligible studies in the review” multiplied by 100 (Katchamart, Faulkner, Feldman, Tomlinson, & Bombardier, p. 806). Eligible studies were identified using the inclusion/exclusion criteria developed by Katchamart et al. The figure for “total number of eligible studies in the review” is taken from that same study, which forms the “gold standard” for this analysis (Katchamart et al., p. 806). Precision is calculated by dividing the total number of eligible citations from a database by the total number of citations returned by the database for the search multiplied by 100 (Katchamart et al., p. 806). The number needed to read (NNR) formula used by the authors is 1/precision, taken from a study by Bachman, Coray, Estermann, and Ter Riet (2002). Main Results — The PubMed search found more results than Ovid MEDLINE for each of the three key concepts – rheumatoid arthritis, MTX and randomized controlled trials. Once the three concepts were combined, PubMed found 106 more articles than Ovid MEDLINE (2036 vs. 1930). Once the review eligibility criteria were applied to the search results from PubMed, 18 eligible articles were identified, one more article than in Ovid MEDLINE. The authors indicated that the additional article located in PubMed was from a journal that was not yet indexed by MEDLINE at the time the relevant article was published. To determine database sensitivity, these numbers were then divided by 20, the total number of eligible studies located in the Katachamart et al. 2009 review, which employed tools like EMBASE and strategies like hand searching in addition to MEDLINE in order to identify relevant studies. Because of the additional study it located, the sensitivity of PubMed was determined to be slightly higher than Ovid MEDLINE (90% vs. 85%). There was little difference between the two databases in terms of precision and NNR. Precision for Ovid MEDLINE was calculated at 0.881% and at 0.884% for PubMed. The NNR was 114 for Ovid MEDLINE and 113 for PubMed. Conclusion — The authors state that while PubMed had a higher calculated sensitivity than Ovid MEDLINE in the context of this particular search because it contained content not indexed by Ovid MEDLINE that proved to be relevant for this topic, its precision and NNR were almost equal to MEDLINE’s. Some technical limitations of the PubMed interface were experienced by researchers during the study, such as periodic instability and the inability to save and modify searches and their results line by line. These same issues did not arise while using Ovid MEDLINE. The need for a skilled translation of Ovid MEDLINE searches for use in the PubMed interface was also emphasized by the authors, as differences in syntax and formatting that are not properly addressed could impact PubMed’s sensitivity and precision.

scholarly journals 4066 In Teenagers Who Smoke Cigarettes Are Nicotine Patches as Compared to Placebo Effective to Decrease the Number of Cigarettes Smoked? – A Systematic Review

2020 ◽  
Vol 4 (s1) ◽  
pp. 138-138
Author(s):  
Obumneke A Amadi
Keyword(s):  
Systematic Review ◽  
Smoking Cessation ◽  
Randomized Controlled Trials ◽  
Nicotine Patch ◽  
Controlled Trials ◽  
Smoking Abstinence ◽  
Randomized Controlled ◽  
Nicotine Patches ◽  
Continuous Abstinence

OBJECTIVES/GOALS: The aim was to examine whether nicotine patch was more effective in encouraging abstinence from cigarettes smoking compared to placebo. METHODS/STUDY POPULATION: Randomized controlled trials involving the general teenage age group smokers who were current smokers-“smoked less than 100 cigarettes over their lifetime and smoked at the time of the interview. Databases were searched for relevant studies reported in English that employed a randomized design published since 2000. Two authors extracted data and assessed quality. The primary outcomes and prioritization were continuous abstinence at 3, 6 and 12-month follow-up or more for the number of patients who responded to treatment, defined as a reduction/abstinence. Heterogeneity between studies did not preclude combined analyses of the data. RESULTS/ANTICIPATED RESULTS: 4 of 266 publications were included. Four studies reported positive effects on smoking cessation at end of treatment: (1) nicotine patches improved continuous abstinence at 6 weeks – 9 weeks months; (2) nicotine patch improved continuous abstinence at 3 to 6 months; (3) nicotine patches improved continuous abstinence 6 and 12 months; (4) nicotine patches improved continuous abstinence at 6 months – 12 and 24 months (5). All studies showed, continuous abstinence at follow up differed in percentage between groups both at 6 weeks through 24 months, with NRT (Nicotine patch) intervention groups achieving higher rates in most of the studies compared to placebo intervention group. Conclusions: NRT intervention methods seem to increase smoking abstinence in those treated for smoking cessation. Further and larger sample size studies are required to make stronger the base of evidence. DISCUSSION/SIGNIFICANCE OF IMPACT: Four randomized controlled trials investigating the effectiveness of smoking cessation interventions, for teenagers who smoke cigarettes were identified for inclusion in this review. Four of the studies reported significant effects on smoking cessation, providing evidence of effectiveness of NRT (nicotine patch), behavioral support and combinations of the two, although not all trials intervention treatments found an effect. The four studies reported important intervention effects at both the short and long follow-ups required: 6 weeks up to the 24 months, thereby, providing stronger evidence to support the effectiveness of NRT intervention on smoking cessation. All studies showed some evidence of improved smoking abstinence outcomes. The four studies had in common that the smoking cessation interventions provided a combination of intent to treat prevention, and of all the clinical trials none of them suggested a negative effect of smoking cessation treatment on substance use outcomes using NRT. However, the studies used reliable methods and reported their cases properly, but the small number of studies reviewed for the systematic review makes the conclusion about the effectiveness of these interventions uncertain. The papers visibly stated how the trials protected against bias, as indicated by the Yes (low risk). No (high risk) and U as “unclear risk.” All four studies conducted a random sequence generation of participants enrolled into the study sample.

scholarly journals Treatment of Tinnitus in Children—A Systematic Review

2021 ◽  
Vol 12 ◽  
Author(s):  
Max J. Dullaart ◽  
Marijn Kip ◽  
Adriana L. Smit ◽  
Inge Stegeman
Keyword(s):  
Systematic Review ◽  
Randomized Controlled Trials ◽  
Observational Studies ◽  
Case Reports ◽  
Case Series ◽  
Controlled Trials ◽  
Eligibility Criteria ◽  
Subjective Tinnitus ◽  
Randomized Controlled

Objectives: To systematically review studies on the effect of treatment of subjective tinnitus in children.Data Sources: We searched for studies in MEDLINE and EMBASE databases, after which additional studies were hand searched using Scopus databases. The methods are described in the study protocol, which has been registered in the PROSPERO register. PRISMA guidelines were followed in the reporting of this study.Eligibility Criteria: We considered for inclusion randomized controlled trials (RCTs), observational studies, case reports, and case series, with tinnitus as primary outcome in children (0–18 years old) with acute or chronic subjective tinnitus. We excluded studies in which both children and adults participated but outcomes were not specifically reported for children, as well as animal studies, studies with a non-original study design and studies about children with pulsatile or objective tinnitus.Data Selection: Two reviewers independently assessed studies for eligibility and quality, collected and extracted data. Statistical analyses were performed in case of homogeneous outcomes.Results: The search yielded a total of 4,447 studies. Of these, 147 eligible studies were selected. One case report and five observational studies met the eligibility criteria. Three studies applied counseling and (simplified-)TRT and reported improvement in tinnitus outcome in 68 out of 82 children after 3–6 months of treatment. Two studies used pharmacological treatments and reported improvement in 74 out of 86 patients after 10 days to 3 months of treatment. One study reported the outcome of biofeedback therapy, describing an improvement in tinnitus loudness and annoyance after 2 months of treatment.Conclusion: Due to the high risk of bias of the included studies, we cannot determine the effectiveness of the treatment of subjective tinnitus in children. Also, owing to brief follow-up periods, it is not possible to draw conclusions regarding long-term effects. Randomized controlled trials with longer follow-up periods are necessary to provide substantial evidence of the effects of therapies for children affected by tinnitus. https://www.crd.york.ac.uk/prospero/Systematic Review Registration:https://www.crd.york.ac.uk/prospero/, identifier [CRD42020178134].

Systematic review and meta-analysis of the effectiveness of radiofrequency ablation in low grade dysplastic Barrett’s esophagus

Endoscopy ◽  
2018 ◽  
Vol 50 (10) ◽  
pp. 953-960 ◽  
Author(s):  
Gargi Pandey ◽  
Mubashir Mulla ◽  
Wyn Lewis ◽  
Antonio Foliaki ◽  
David Chan
Keyword(s):  
Systematic Review ◽  
Radiofrequency Ablation ◽  
Barrett’S Esophagus ◽  
Barrett's Esophagus ◽  
Meta Analysis ◽  
Low Grade ◽  
Short Term ◽  
Recurrence Rates ◽  
Premalignant Condition

Abstract Background Barrett’s esophagus (BE) is a premalignant condition characterized by replacement of the esophageal lining with metastatic columnar epithelium, and its management when complicated by low grade dysplasia (LGD) is controversial. This systematic review and meta-analysis aimed to determine the efficacy of radiofrequency ablation (RFA) in patients with LGD. Methods MEDLINE, EMBASE, and Web of Science were searched for studies including patients with BE-associated LGD receiving RFA (January 1990 to May 2017). The outcome measures were complete eradication of intestinal metaplasia (CE-IM) and dysplasia (CE-D), rates of progression to high grade dysplasia (HGD) or cancer, and recurrence. Results Eight studies including 619 patients with LGD (RFA = 404, surveillance = 215) were analyzed. After a median follow-up of 26 months (range 12 – 44 months), the overall pooled rates of CE-IM and CE-D after RFA were 88.17 % (95 % confidence interval [CI] 88.13 % – 88.20 %; P < 0.001) and 96.69 % (95 %CI 96.67 % – 96.71 %; P < 0.001), respectively. When compared with surveillance, RFA resulted in significantly lower rates of progression to HGD or cancer (odds ratio [OR] 0.07, 95 %CI 0.02 – 0.22). The pooled recurrence rates of IM and dysplasia were 5.6 % (95 %CI 5.57 – 5.63; P < 0.001) and 9.66 % (95 %CI 9.61 – 9.71; P < 0.001), respectively. Conclusions RFA safely eradicates IM and dysplasia and reduces the rates of progression from LGD to HGD or cancer in the short term.

scholarly journals POS0800 VISUAL ISCHEMIA DURING RELAPSE AND FOLLOW-UP OF GIANT CELL ARTERITIS: A SYSTEMATIC REVIEW

2021 ◽  
Vol 80 (Suppl 1) ◽  
pp. 652.2-652
Author(s):  
K. Bugdayli ◽  
P. Ungprasert ◽  
K. J. Warrington ◽  
M. Koster
Keyword(s):  
Systematic Review ◽  
Randomized Controlled Trials ◽  
Giant Cell Arteritis ◽  
Giant Cell ◽  
Retrospective Studies ◽  
Controlled Trials ◽  
Inclusion Criteria ◽  
Randomized Controlled ◽  
Rate Frequency

Background:Visual ischemia (VI) is one of the most feared complications in giant cell arteritis (GCA). While the frequencies of VI development at or near diagnosis are better studied, limited information is available regarding the frequency of VI during relapse.Objectives:The purpose of this study was to characterize the frequency of visual ischemia (VI) as a manifestation of relapse or during follow-up in patients with GCA through performance of a systematic literature review.Methods:Potentially eligible studies were identified from Medline and EMBASE databases from inception to November 31, 2019 using a search strategy that comprised of terms for “giant cell arteritis,” “temporal arteritis,” or “Horton’s disease,” with “relapse,” “recurrence,” “flare,” “outcome,” “follow-up,” or “prognosis.” VI was defined as transient or permanent, full or partial, monocular or binocular visual field loss. VI occurring within 4 wks of GCA diagnosis was considered due to active disease and not included as a relapse event. Inclusion criteria used: (1) original research reported in English, (2) GCA definition provided, (3) VI outcome described as one of the following: (a) relapse rate/frequency denoting the presence or absence of VI, or (b) absolute number of VI events (> 4 weeks after GCA diagnosis) even if total cohort relapse rate/frequency was not provided. In order to reduce bias from under-reporting of negative results, studies that reported relapse rates/frequencies with accompanying relapse characteristics but did not provide initial detail regarding the presence/absence of VI were also identified. In such circumstances, the primary authors were directly contacted for patient-level data regarding VI and these studies were included in the final analysis if such data were available and provided.Results:A total of 913 unique articles were identified and underwent screening. Among these, 148 articles underwent independent full-text review by two physicians (K.B. and M.J.K). 33 articles met full inclusion criteria and an additional 21 articles included data on relapse but did not report VI patient data in the publication. Responses were received from authors of 11 of these 21 studies allowing for inclusion. 44 studies accounting for 3,649 patients with GCA were identified. Average percentage of baseline VI was 19% (range 0-66%). The average length of follow-up was 3.4 years (range 0.4 to 8.7). VI developing > 4 weeks after GCA diagnosis was recorded in a total of 53 patients (1.5%).Study-defined relapses were reported in 36 studies. A total of 1,215 patients with at least one or more relapses were recorded among 2,592 patients under observation (47%). Among these 36 studies, VI occurred in 37 patients (3.0%) with at least one study defined relapse event.Comparing trial design, retrospective studies (n=25) reported 27 of 2,718 (1%) patients developed VI during follow-up whereas 19 of 541 (3.5%) patients in randomized controlled trials (n=8) developed VI during the trial or post-trial follow-up.Conclusion:This report outlines the first systematic review evaluating VI as a manifestation of relapse and during follow-up in GCA. Overall, VI > 4 weeks after GCA diagnosis is uncommon (1.5%) but is noted in up to 3% of patients with at least one relapse event. Frequencies of reported VI were 3.5 times higher in randomized controlled trials compared to retrospective studies.Disclosure of Interests:Kubra Bugdayli: None declared, Patompong Ungprasert: None declared, Kenneth J Warrington Grant/research support from: Financial support for research from Kiniksa, Eli Lilly, Matthew Koster: None declared

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