PDF(Sci-hub)
Abstract：
BACKGROUND: 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).
METHODS: 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 We also searched for unpublished literature (e.g. relevant websites).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.
RESULTS: 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.
CONCLUSIONS: 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.
BACKGROUND: PROSPERO (CRD42017049993 [KQ1], CRD42017050014 [KQ2], CRD42018084825 [KQ3]).
METHODS: 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.
RESULTS: 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.
CONCLUSIONS: 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.
BACKGROUND: PROSPERO (CRD42017049993 [KQ1], CRD42017050014 [KQ2], CRD42018084825 [KQ3]).
摘要：
背景：为加拿大预防保健工作组提供了两项关于在没有报警症状的慢性胃食管反流病（GERD）患者中筛查食管腺癌的指南综述和概述。目标是系统地回顾三个关键问题（KQs）：（1）筛查这些疾病的有效性；（2）患有慢性GERD的成年人如何权衡筛查的益处和危害，以及哪些因素有助于他们的偏好和决定进行筛查；和（3）巴雷特食管（BE）的治疗方案，发育不良或1期EAC（综述概述）。
方法：在2018年10月检索了每篇综述的书目数据库（例如OvidMEDLINE®）。我们还搜索了未发表的文献（例如相关网站）。自由加速方法用于标题和摘要筛选。两名审稿人独立筛选全文文章。数据提取和偏倚风险评估由一名审阅者完成，并由另一名审阅者（KQ1和2）验证。质量评估由两名审稿人独立完成，一式两份（KQ3）。通过讨论解决了分歧。我们使用了各种适用于研究设计的偏见风险工具。等级框架用于对证据的确定性进行评级。
结果：10项研究评估了筛查的有效性。一项回顾性研究报告，曾进行过食管胃十二指肠镜检查的患者和未进行过食管胃十二指肠镜检查的患者的长期生存（约6至12年）没有差异（校正HR0.93，95％置信区间（CI）0.58-1.50）。尽管如果在过去5年中进行了EGD，则1期诊断的几率可能高于更高级的诊断（2-4期）（OR2.27，95％CI1.00-7.67）。七项研究比较了不同的筛查方式，模式之间几乎没有区别。三项研究报告了患者不愿接受筛查(例如，由于焦虑，害怕呕吐)。11项系统评价评估了治疗方式，为某些结局提供一些早期治疗效果的证据。
结论：关于筛查的有效性以及筛查的价值观和偏好的证据很少。已经评估了许多治疗方式，但是研究很小。总的来说,在了解筛查和早期治疗的有效性方面存在不确定性.
背景：PROSPERO（CRD42017049993[KQ1]，CRD42017050014[KQ2],CRD42018084825[KQ3])。
方法：在2018年10月检索了每篇综述的书目数据库（例如OvidMEDLINE®）。我们还搜索了未发表的文献（例如相关网站）。自由加速方法用于标题和摘要筛选。两名审稿人独立筛选全文文章。数据提取和偏倚风险评估由一名审阅者完成，并由另一名审阅者（KQ1和2）验证。质量评估由两名审稿人独立完成，一式两份（KQ3）。通过讨论解决了分歧。我们使用了各种适用于研究设计的偏见风险工具。等级框架用于对证据的确定性进行评级。
结果：10项研究评估了筛查的有效性。一项回顾性研究报告，曾进行过食管胃十二指肠镜检查的患者和未进行过食管胃十二指肠镜检查的患者的长期生存（约6至12年）没有差异（校正HR0.93，95％置信区间（CI）0.58-1.50）。尽管如果在过去5年中进行了EGD，则1期诊断的几率可能高于更高级的诊断（2-4期）（OR2.27，95％CI1.00-7.67）。七项研究比较了不同的筛查方式，模式之间几乎没有区别。三项研究报告了患者不愿接受筛查(例如，由于焦虑，害怕呕吐)。11项系统评价评估了治疗方式，为某些结局提供一些早期治疗效果的证据。
结论：关于筛查的有效性以及筛查的价值观和偏好的证据很少。已经评估了许多治疗方式，但是研究很小。总的来说,在了解筛查和早期治疗的有效性方面存在不确定性.
背景：PROSPERO（CRD42017049993[KQ1]，CRD42017050014[KQ2],CRD42018084825[KQ3])。
