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Systematic review with meta‐analysis: neoplasia detection rate and post‐endoscopy Barrett's neoplasia in Barrett's oesophagus
Author(s) -
Hamade Nour,
Kamboj Amrit K.,
Krishnamoorthi Rajesh,
Singh Siddharth,
Hassett Leslie C.,
Katzka David A.,
Kahi Charles J.,
Fatima Hala,
Iyer Prasad G.
Publication year - 2021
Publication title -
alimentary pharmacology and therapeutics
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.308
H-Index - 177
eISSN - 1365-2036
pISSN - 0269-2813
DOI - 10.1111/apt.16531
Subject(s) - medicine , dysplasia , gastroenterology , endoscopy , barrett's esophagus , barrett's oesophagus , colonoscopy , adenocarcinoma , cancer , colorectal cancer
Summary Background Neoplasia detection rate, the proportion of Barrett's oesophagus patients with high‐grade dysplasia or oesophageal adenocarcinoma detected at index surveillance endoscopy has been proposed as a quality metric. However, the correlation between neoplasia detection rate and a clinically relevant outcome like post‐endoscopy Barrett's neoplasia remains unknown. Post‐endoscopy Barrett's neoplasia refers to the rate of high‐grade dysplasia or oesophageal adenocarcinoma on repeat endoscopy within one year of an index screening examination revealing non‐dysplastic Barrett's oesophagus or low‐grade dysplasia. Aim To assess correlation between neoplasia detection rate and post‐endoscopy Barrett's neoplasia. Methods We performed a systematic search of multiple databases from date of inception to June 2021 to identify cohort studies reporting both neoplasia detection rate and post‐endoscopy Barrett's neoplasia. Data from each study were pooled using a random effects model, and their correlation assessed using meta‐regression. Heterogeneity was assessed and a priori planned subgroup analyses were conducted. Results Ten studies with 27 894 patients with Barrett's oesophagus were included. The pooled neoplasia detection rate and post‐endoscopy Barrett's neoplasia were 5.0% (95% CI: 3.4%‐7.1%, I 2 = 97%) and 19.6% (95% CI: 10.1%‐34.7%, I 2 = 96%), respectively. Meta‐regression revealed a statistically significant inverse relationship between the two variables (coefficient −3.50, 95% CI: −4.63 to −2.37, P < 0.01). With every 1% increase of neoplasia detection rate, post‐endoscopy Barrett's neoplasia decreased by 3.50%. Heterogeneity was high despite adjusting for study quality and performing several subgroup analyses. Conclusion We observed a statistically significant inverse correlation between neoplasia detection rate and post‐endoscopy Barrett's neoplasia. Additional studies are needed to further validate this correlation.