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标题:Incidence of esophageal adenocarcinoma in Barrett's esophagus with low-grade dysplasia: a systematic review and meta-analysis.
时间:2019-12-04 06:32:31
DOI:10.1016/j.gie.2014.01.009
PMID:24556051
作者:Singh, Siddharth; Manickam, Palaniappan; Amin, Anita V.
关键词:BEBarrett's esophagus;Barrett's esophagus;EACesophageal adenocarcinoma;esophageal adenocarcinoma;HGDhigh-grade dysplasia;high-grade dysplasia;IRincidence rate;incidence rate;LGDlow-grade dysplasia;low-grade dysplasia
出版源: 《Gastrointestinal Endoscopy》 ,79 (6) :897-909.e4
摘要:The natural history of low-grade dysplasia (LGD) in patients with Barrett's esophagus (BE) is unclear. We performed a systematic review and meta-analysis of studies that reported the incidence of esophageal adenocarcinoma (EAC) and/or high-grade dysplasia (HGD) among patients with BE with LGD. Systematic review and meta-analysis of cohort studies. Patients with BE-LGD, with mean cohort follow-up ≥2 years. Pooled incidence rates with 95% confidence intervals (CI) of EAC and/or BE-HGD. We identified 24 studies reporting on 2694 patients with BE-LGD, with 119 cases of EAC. Pooled annual incidence rates of EAC alone and EAC and/or HGD in patients with BE-LGD were 0.54% (95% CI, 0.32-0.76; 24 studies) and 1.73% (95% CI, 0.99-2.47; 17 studies). The results were stable across study setting and location and in high-quality studies. Substantial heterogeneity was observed, which could be explained by stratifying based on LGD/BE ratio as a surrogate for quality of pathology; the pooled annual incidence rates of EAC were 0.76% (95% CI, 0.44-1.09; 14 studies) for LGD/BE ratio <0.15 and 0.32% (95% CI, 0.07-0.58; 10 studies) for LGD/BE ratio >0.15. The annual rate of mortality not related to esophageal disease in patients with BE-LGD was 4.7% (95% CI, 3.2-6.2; 4 studies). Substantial heterogeneity was observed in the overall analysis. The incidence of EAC among patients with BE-LGD is 0.54% annually. The LGD/BE ratio appears to explain the variation observed in the reported incidence of EAC in different cohorts. Conditions not related to esophageal disease are a major cause of mortality in patients with BE-LGD, although additional studies are warranted.
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目录:
  • Incidence of esophageal adenocarcinoma in Barrett's esophagus with low-grade dysplasia: a systematic review and meta-analysis
    • Methods
      • Search strategy
      • Study selection
      • Data abstraction and quality assessment
      • Outcomes assessed
      • Statistical analysis
    • Results
      • Characteristics and quality of included studies
      • Incidence of esophageal adenocarcinoma
      • Subgroup analysis
      • Sensitivity analysis and publication bias
      • Incidence of mortality from conditions not related to esophageal disease
    • Discussion
    • References
    • Appendix

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