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Meta-analysis and systematic review of colorectal endoscopic mucosal resection

World Journal of Gastroenterology 2009年第34期15卷 4273-4277页

作者： Srinivas r Puli Yasuo Kakugawa Takuji Gotoda Daphne antillon Yutaka Saito mainor r antillon Division of Gastroenterology and Hepatology University of Missouri-Columbia Endoscopy Division National Cancer Center Hospital

AIM:To evaluate the proportion of successful complete cure en-bloc resections of large colorectal polyps achieved by endoscopic mucosal resection(EMr). METHODS:Studies using the EMr technique to resect large colorectal polyps were *** complete cure en-bloc resection was defined as one piece margin-free polyp *** were searched for in Medline,Pubmed,and the Cochrane Control Trial registry,among other sources. rESULTS:An initial search identified 2620 reference articles,from which 429 relevant articles were selected and *** was extracted from 25 studies(n =5221)which met the inclusion *** the studies used snares to perform *** proportion of en-bloc resections using a random effect model was 62.85%(95%CI:51.50-73.52).The pooled proportion for complete cure en-bloc resections using a random effect model was 58.66%(95%CI:47.14-69.71).With higher patient load(>200 patients),this complete cure en-bloc resection rate improves from 44.19%(95%CI: 24.31-65.09)to 69.17%(95%CI:51.11-84.61). CONCLUSION:EMr is an effective technique for the resection of large colorectal polyps and offers an alternative to surgery.

关键词： Meta-analysis Systematic review Polyps Endoscopic mucosal resection En-bloc resection

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Staging accuracy of esophageal cancer by endoscopic ultrasound:A meta-analysis and systematic review

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World Journal of Gastroenterology 2008年第10期14卷 1479-1490页

作者： Srinivas r Puli Jyotsna BK reddy Matthew L Bechtold Daphne antillon Jamal A Ibdah mainor r antillon Division of Gastroenterology and Hepatology University of Missouri-Columbia Columbia Missouri 65212 United States

AIM: To evaluate the accuracy of endoscopic ultrasound (EUS) in the staging of esophageal cancer. METHODS: Only EUS studies confirmed by surgery were selected. Articles were searched in Medline and Pubmed. Two reviewers independently searched and extracted data. Meta-analysis of the accuracy of EUS was analyzed by calculating pooled estimates of sensitivity, specificity, likelihood ratios, and diagnostic odds ratio. Pooling was conducted by both the Mantel-Haenszel method (fixed effects model) and DerSimonian Laird method (random effects model). The heterogeneity of studies was tested using Cochran’s Q test based upon inverse variance weights. rESULTS: Forty-nine studies (n = 2558) which met the inclusion criteria were included in this analysis. Pooled sensitivity and specificity of EUS to diagnose T1 was 81.6% (95% CI: 77.8-84.9) and 99.4% (95% CI: 99.0-99.7), respectively. To diagnose T4, EUS had a pooled sensitivity of 92.4% (95% CI: 89.2-95.0) and specificity of 97.4% (95% CI: 96.6-98.0). With Fine Needle Aspiration (FNA), sensitivity of EUS to diagnose N stage improved from 84.7% (95% CI: 82.9-86.4) to 96.7% (95% CI: 92.4-98.9). The P value for the χ2 test of heterogeneity for all pooled estimates was > 0.10. CONCLUSION: EUS has excellent sensitivity and specificity in accurately diagnosing the TN stage of esophageal cancer. EUS performs better with advanced (T4) than early (T1) disease. FNA substantially improves the sensitivity and specificity of EUS in evaluating N stage disease. EUS should be strongly considered for staging esophageal cancer.

关键词： Esophageal cancer Cancer staging Endoscopic ultrasound, TNM staging, Diagnostic accuracy

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Endoscopic ultrasound:It’s accuracy in evaluating mediastinal lymphadenopathy? A meta-analysis and systematic review

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World Journal of Gastroenterology 2008年第19期14卷 3028-3037页

作者： Srinivas r Puli Jyotsna Batapati Krishna reddy Matthew L Bechtold Jamal A Ibdah Daphne antillon Shailender Singh Mojtaba Olyaee mainor r antillon Division of Gastroenterology and Hepatology University of Missouri- Columbia Division of Gastroenterology and Hepatology University of Kansas School of Medicine

AIM:To evaluate the accuracy of endoscopic ultrasound (EUS), EUS-fine needle aspiration (FNA) in evaluating mediastinal lymphadenopathy. METHODS:Only EUS and EUS-FNA studies confirmed by surgery or with appropriate follow-up were selected. Articles were searched in Medline, Pubmed, and Cochrane control trial registry. Only studies from which a 2 × 2 table could be constructed for true positive, false negative, false positive and true negative values were included. Two reviewers independently searched and extracted data. The differences were resolved by mutual agreement. Meta-analysis for the accuracy of EUS was analyzed by calculating pooled estimates of sensitivity, specificity, likelihood ratios, and diagnostic odds ratios. Pooling was conducted by both Mantel-Haenszel method (fixed effects model) and DerSimonian Laird method (random effects model). The heterogeneity of studies was tested using Cochran’s Q test based upon inverse variance weights. rESULTS:Data was extracted from 76 studies (n = 9310) which met the inclusion criteria. Of these, 44 studies used EUS alone and 32 studies used EUS-FNA. FNA improved the sensitivity of EUS from 84.7% (95% CI:82.9-86.4) to 88.0% (95% CI:85.8-90.0). With FNA, the specificity of EUS improved from 84.6% (95% CI:83.2-85.9) to 96.4% (95% CI:95.3-97.4). The P forchi-squared heterogeneity for all the pooled accuracy estimates was > 0.10. CONCLUSION:EUS is highly sensitive and specific for the evaluation of mediastinal lymphadenopathy and FNA substantially improves this. EUS with FNA should be the diagnostic test of choice for evaluating mediastinal lymphadenopathy.

关键词： Endoscopic ultrasound EUS-fine needleaspiration Mediastinal lymphadenopathy

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How good is endoscopic ultrasound for TNM staging of gastric cancers? A meta-analysis and systematic review

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World Journal of Gastroenterology 2008年第25期14卷 4011-4019页

作者： Srinivas reddy Puli Jyotsna Batapati Krishna reddy Matthew L Bechtold mainor r antillon Jamal A Ibdah Division of Gastroenterology and Hepatology University of Missouri-Columbia

AIM: To evaluate the accuracy of endoscopic ultrasound (EUS) for staging of gastric cancers. METHODS: Only EUS studies confirmed by surgery were selected. Only studies from which a 2 × 2 table could be constructed for true positive, false negative, false positive and true negative values were included. Articles were searched in Medline, Pubmed, Ovid journals, Cumulative index for nursing & allied health literature, International pharmaceutical abstracts, old Medline, Medline nonindexed citations, and Cochrane control trial registry. Two reviewers independently searched and extracted data. The differences were resolved by mutual agreement. 2 × 2 tables were constructed with the data extracted from each study. Meta-analysis for the accuracy of EUS was analyzed by calculating pooled estimates of sensitivity, specifi city, likelihood ratios, and diagnostic odds ratio. Pooling was conducted by both the Mantel-Haenszel method (fi xed effects model) and DerSimonian Laird method (random effects model). The heterogeneity of studies was tested using Cochran's Q test based upon inverse variance weights. rESULTS: Initial search identified 1620 reference articles and of these, 376 relevant articles were selected and reviewed. Twenty-two studies (n = 1896) which met the inclusion criteria were included in this analysis. Pooled sensitivity of T1 was 88.1% (95% CI: 84.5-91.1) and T2 was 82.3% (95% CI: 78.2-86.0). For T3, pooled sensitivity was 89.7% (95% CI: 87.1-92.0). T4 hada pooled sensitivity of 99.2% (95% CI: 97.1-99.9). For nodal staging, the pooled sensitivity for N1 was 58.2% (95% CI: 53.5-62.8) and N2 was 64.9% (95% CI: 60.8-68.8). Pooled sensitivity to diagnose distant metastasis was 73.2% (95% CI: 63.2-81.7). The P for chi-squared heterogeneity for all the pooled accuracy estimates was > 0.10. CONCLUSION: EUS results are more accurate with advanced disease than early disease. If EUS diagnoses advanced disease, such as T4 disease, the patient is 500 times more likely to h

关键词： Gastric cancer Staging Meta-analysis Endoscopic ultrasound

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