Diagnostic performance of EUS in predicting advanced cancer among patients with Barrett's esophagus and high-grade dysplasia/early adenocarcinoma: Systematic review and meta-analysis

Background The role of EUS among patients with Barrett's esophagus (BE) with high-grade dysplasia (HGD) or suspected mucosal carcinoma is controversial. Objective To define the role of EUS in detecting advanced disease among patients with BE. Design Systematic review and meta-analysis. Setting MEDLINE, Embase, Web of Science, and Cochrane Central databases. Patients Patients with BE and HGD or esophageal adenocarcinoma (EAC) who were referred for endoscopic evaluation and underwent EUS. Interventions EUS. Main Outcome Measurements Pooled proportion of patients with advanced EAC identified by EUS among patients with BE who are referred for HGD or EAC (with or without visible lesions). Forest plots were used to contrast effect sizes in each of the studies and random effect models when tests of heterogeneity were significant (I² > 50% or P <.1 for the Q statistic). Results Of 1278 articles, 47 were reviewed in full text, and 11 articles met the inclusion criteria, including a total of 656 patients. Based on a random-effects model, the proportion of patients with advanced disease detected on EUS was 14% (95% confidence interval, 8%-22%; P <.0001). In a subanalysis, the pooled proportion of patients with advanced disease on EUS in the absence of nodules was 4% (95% confidence interval, 2%-6%, P <.0001). Limitations Significant heterogeneity among studies. Conclusions EUS will result in a change in the therapeutic approach among in a significant minority of patients with BE who are referred for HGD or EAC.