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Systematic review of the impact of endoscopic ultrasound on the management of patients with esophageal cancer

Published online by Cambridge University Press:  24 January 2008

Suzanne M. Dyer ,
Dane B. Levison ,
Robert Y. Chen ,
Sarah J. Lord  and
Stephen Blamey
Suzanne M. Dyer
Affiliation:
NHMRC Clinical Trials Centre
Dane B. Levison
Affiliation:
IMS Health
Robert Y. Chen
Affiliation:
St. Vincent's Hospital
Sarah J. Lord
Affiliation:
NHMRC Clinical Trials Centre
Stephen Blamey
Affiliation:
Monash Medical Centre
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Abstract

Objectives: Although endoscopic ultrasound (EUS) staging of esophageal cancer is established in clinical practice, high-quality evidence about its impact on patient outcomes is not available. This study aims to determine the impact of EUS for esophageal cancer staging on patient management and survival.

Methods: A systematic review was conducted using Medline, PreMedline, Embase, and The Cochrane Library. Included studies were (i) comparative studies reporting survival following EUS esophageal cancer staging, (ii) therapeutic impact studies reporting change in patient management following EUS. The quality of included studies was critically appraised.

Results: One systematic review, five studies reporting therapeutic impact, and two studies reporting patient survival were identified. The design and quality of the therapeutic impact studies varied widely. Management changed in 24–29 percent of patients following EUS staging of esophageal cancer (two studies). No studies provided data on the avoidance of surgery for this indication. One retrospective cohort study with historical control found EUS staging of esophageal cancer improved patient survival; a second study with similar design limitations did not find a survival benefit for EUS staging in patients undergoing resection. These studies had a high potential for bias, limiting the value of these findings.

Conclusions: Two studies provided evidence of a change in patient management following EUS for staging esophageal cancer, a higher level of evidence for a clinical benefit than can be obtained from accuracy studies alone. This evidence contributed to a recommendation for public funding of EUS in staging esophageal cancer in Australia.

Keywords

EndosonographyEsophageal neoplasmsEvidence-based medicineBiomedical technology assessmentPatient outcomes assessment
Type
GENERAL ESSAYS
Information
International Journal of Technology Assessment in Health Care , Volume 24 , Issue 1 , January 2008 , pp. 25 - 35
Copyright
Copyright © Cambridge University Press 2008

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References

REFERENCES

1. Allum, WH, Griffin, SM, Watson, A, Colin-Jones, D. Guidelines for the management of oesophageal and gastric cancer. Gut. 2002;50 (Suppl 5):1–23.CrossRefGoogle ScholarPubMed
2. Chen, J, Xu, R, Hunt, GC, Krinsky, ML, Savides, TJ. Influence of the number of malignant regional lymph nodes detected by endoscopic ultrasonography on survival stratification in esophageal adenocarcinoma. Clin Gastroenterol Hepatol. 2006;4:573–579.CrossRefGoogle ScholarPubMed
3. Chong, AK, Caddy, GR, Desmond, PV, Chen, RY. Prospective study of the clinical impact of EUS. Gastrointest Endosc. 2005;62:399–405.CrossRefGoogle ScholarPubMed
4. Davies, AR, Deans, DA, Penman, I, et al. The multidisciplinary team meeting improves staging accuracy and treatment selection for gastro-esophageal cancer. Dis Esophagus. 2006;19:496–503.CrossRefGoogle ScholarPubMed
5. Eloubeidi, MA, Wallace, MB, Hoffman, BJ, et al. Predictors of survival for esophageal cancer patients with and without celiac axis lymphadenopathy: Impact of staging endosonography. Ann Thorac Surg. 2001;72:212–219.CrossRefGoogle ScholarPubMed
6. Fryback, DG, Thornbury, JR. The efficacy of diagnostic imaging. Med Decis Making. 1991;11:88–94.Google Scholar
7. Guyatt, GH, Tugwell, PX, Feeny, DH, Drummond, MF, Haynes, RB. The role of before-after studies of therapeutic impact in the evaluation of diagnostic technologies. J Chronic Dis. 1986;39:295–304.Google Scholar
8. Harewood, GC, Kumar, KS. Assessment of clinical impact of endoscopic ultrasound on esophageal cancer. J Gastroenterol Hepatol. 2004;19:433–439.CrossRefGoogle ScholarPubMed
9. Harris, KM, Kelly, S, Berry, E, J et al. Systematic review of endoscopic ultrasound in gastro-oesophageal cancer. Health Technol Assess. 1998;2:i–134.Google Scholar
10. Jafri, IH, Saltzman, JR, Colby, JM, Krims, PE. Evaluation of the clinical impact of endoscopic ultrasonography in gastrointestinal disease. Gastrointest Endosc. 1996;44:367–370.CrossRefGoogle ScholarPubMed
11. Kelly, S, Harris, KM, Berry, E, et al. A systematic review of the staging performance of endoscopic ultrasound in gastro-oesophageal carcinoma. Gut. 2001;49:534–539.CrossRefGoogle ScholarPubMed
12. Lightdale, CJ, Kulkarni, KG. Role of endoscopic ultrasonography in the staging and follow-up of esophageal cancer. J Clin Oncol. 2005;23:4483–4489.CrossRefGoogle ScholarPubMed
13. Lord, SJ, Irwig, L, Simes, RJ. When is measuring sensitivity and specificity sufficient to evaluate a diagnostic test and when do we need randomized trials. Ann Intern Med. 2006;144:850–855.Google Scholar
14. Mariette, C, Balon, JM, Maunoury, V, et al. . Value of endoscopic ultrasonography as a predictor of long-term survival in oesophageal carcinoma. Br J Surg. 2003;90:1367–1372.CrossRefGoogle ScholarPubMed
15. Marsman, WA, van Wissen, M, Bergman, JJ, et al. Outcome of patients with esophageal carcinoma and suspicious celiac lymph nodes as determined by endoscopic ultrasonography. Endoscopy. 2004;36:961–965.Google Scholar
16. MSAC. Endoscopic ultrasound. Canberra: Medical Services Advisory Committee (MSAC), Commonwealth of Australia; 2007. In press.Google Scholar
17. NHS. Cancer of the oesophagus or gastricus: New assessment of the technology of endosonography (COGNATE). NHS Health Technology Assessment Programme 2006. Available at: http://www.hta.ac.uk/project.asp?PjtId=1368. Accessed August 14, 2006.Google Scholar
18. NHS Centre for Reviews and Dissemination. Undertaking systematic reviews of research on effectiveness. In: Khan, KS, Riet, G, Glanville, J, Sowden, AJ, Kleijnen, J, eds. CRD report 4 (2nd ed). 2001. University of York, UK: York Publishing Services Ltd; 2001.Google Scholar
19. Nickl, NJ, Bhutani, MS, Catalano, M, et al. . Clinical implications of endoscopic ultrasound: The American Endosonography Club Study. Gastrointest Endosc. 1996;44:371–377.CrossRefGoogle ScholarPubMed
20. Parmar, KS, Zwischenberger, JB, Reeves, AL, Waxman, I. Clinical impact of endoscopic ultrasound-guided fine needle aspiration of celiac axis lymph nodes (M1a disease) in esophageal cancer. Ann Thorac Surg. 2002;73:916–920.CrossRefGoogle ScholarPubMed
21. Pech, O, May, A, Gunter, E, Gossner, L, Ell, C. The impact of endoscopic ultrasound and computed tomography on the TNM staging of early cancer in Barrett's esophagus. Am J Gastroenterol. 2006;101:2223–2229.CrossRefGoogle ScholarPubMed
22. Preston SR, Clark GW, Martin IG, Ling HM, Harris KM. Effect of endoscopic ultrasonography on the management of 100 consecutive patients with oesophageal and junctional carcinoma. Br J Surg. 2003;90:1220–1224.Google Scholar
23. Shah JN, Ahmad NA, Beilstein MC, Ginsberg GG, Kochman ML. Clinical impact of endoscopic ultrasonography on the management of malignancies. Clin Gastroenterol Hepatol. 2004;2:1069–1073.CrossRefGoogle Scholar
24. van Westreenen, HL, Heeren, PA, van Dullemen, HM, et al. . Positron emission tomography with F-18-fluorodeoxyglucose in a combined staging strategy of esophageal cancer prevents unnecessary surgical explorations. J Gastrointest Surg. 2005;9:54–61.Google Scholar
25. Vazquez-Sequeiros, E, Wiersema, MJ, Clain, JE, et al. . Impact of lymph node staging on therapy of esophageal carcinoma. Gastroenterology. 2003;125:1626–1635.Google Scholar
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