PROSPERO

International prospective register of systematic reviews

Surgery versus endoscopic therapies for early cancer and high-grade dysplasia in the
esophagus: a systematic review and meta-analysis of randomised and non-randomised
trials
Fabio Alberto Castillo Bustamante

Citation
Fabio Alberto Castillo Bustamante. Surgery versus endoscopic therapies for early cancer and high-
grade dysplasia in the esophagus: a systematic review and meta-analysis of randomised and non-
randomised trials. PROSPERO 2014 CRD42014013170 Available from:
http://www.crd.york.ac.uk/PROSPERO/display_record.php?ID=CRD42014013170

Review question
The aim of this systematic review is to identify studies that statistically compare survival, disease-free time
and resectability in the endoscopic versus surgical treatment (Randomized Controlled Trial, Controlled
Clinical Trial, Comparative Study), and affirm with numbers in hand, what intervention would be indicated for
early lesions in esophageal cancer.

Searches
Data sources: A systematic review of English and non-English articles using MEDLINE and the Cochrane
Central Register of Controlled Trials (CENTRAL), EMBASE, EBSCO, LILACS, Library University of Sao
Paulo, Research website BVS and SCOPE Science Direct.

Types of study to be included

Randomized Controlled Trial, Controlled Clinical Trial, Comparative Study

Condition or domain being studied

Disease confined to the esophagus, or local disease is present in 22% of cases. A minority of patients have
disease that is limited to the mucosa or submucosa (ie, T1N0) and esophagectomy is the first line of therapy
for patients with stage T1N0M0. For patients with localized, potentially resectable disease, median survival
strongly correlates with disease stage. Advanced age and comorbidities increase the risk of postoperative
cardiorespiratory complications, anastomotic leakage, reoperation rates, wound infection and death (CJ.,
1999). Endoscopic resection (ER) is an alternative to surgical resection of mucosal and submucosal
neoplastic lesions and intramucosal cancers, with the benefit of not being associated with major surgery
complications. Endoscopic mucosal resection (EMR), endoscopic submucosal dissection (ESD),
photodynamic therapy (PDT), laser therapy, and argon plasma coagulation (APC) have been developed as
an alternative to surgical resection for early lesions. The benefit of these therapies is obvious, and is
demonstrated in multiple case series publications, including also systematic reviews with no statistical data
analysis, that does not make clear, from the point of view of evidence-based medicine, the benefits of these
therapies compared with surgery. (Systematic Review Sgourakis G, 2013) (Systematic Review Menon D,
2010) (Systematic Review Bennett C, 2012) (Systematic Review Bennett C G. S., 2010) (Systematic Review
Green S, 2009).

Participants/population
Patients with early esophageal cancer

Intervention(s), exposure(s)
Endoscopic mucosal resection (EMR), endoscopic submucosal dissection (ESD), photodynamic therapy
(PDT), laser therapy, and argon plasma coagulation (APC)

Comparator(s)/control

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PROSPERO
International prospective register of systematic reviews

Esophagectomy

Primary outcome(s)
survival, disease-free time

Timing and effect measures

survival, disease-free time

Secondary outcome(s)
resectability

Timing and effect measures

resectability

Data extraction (selection and coding)

Risk of bias (quality) assessment
Only retrospective comparative studies exist in the literature.

Strategy for data synthesis

Systematic review will identify studies that statistically compare survival, disease-free time and resectability
in the endoscopic versus surgical treatment (Randomized Controlled Trial, Controlled Clinical Trial,
Comparative Study), and affirm with numbers in hand, what intervention would be indicated for early lesions
in esophageal cancer.

Analysis of subgroups or subsets

None planned

Contact details for further information

Fabio Alberto Castillo Bustamante
facastillobu@gmail.com

Organisational affiliation of the review

Serviço de Endoscopia Gastrointestinal do HCFMUSP
http://www.endoscopiahcfmusp.com.br/

Review team members and their organisational affiliations

Dr Fabio Alberto Castillo Bustamante.

Collaborators
Professor Eduardo Moura. Serviço de Endoscopia Gastrointestinal do HCFMUSP

Anticipated or actual start date

17 March 2014

Anticipated completion date

17 November 2014

Funding sources/sponsors
Serviço de Endoscopia Gastrointestinal do HCFMUSP

Conflicts of interest
None known

Language
English

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 PROSPERO
International prospective register of systematic reviews

Country
Brazil

Stage of review
Review_Ongoing

Subject index terms status

Subject indexing assigned by CRD

Subject index terms

Barrett Esophagus; Early Detection of Cancer; Endoscopy; Humans; Neoplasms;

Date of registration in PROSPERO

10 August 2014

Date of publication of this version

10 August 2014

Details of any existing review of the same topic by the same authors
Stage of review at time of this submission

Stage Started Completed

Preliminary searches No Yes

Piloting of the study selection process No Yes

Formal screening of search results against eligibility criteria No Yes

Data extraction Yes No

Risk of bias (quality) assessment No No

Data analysis No No

Versions
10 August 2014

PROSPERO
This information has been provided by the named contact for this review. CRD has accepted this information in good
faith and registered the review in PROSPERO. CRD bears no responsibility or liability for the content of this registration
record, any associated files or external websites.

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