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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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