title: 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.
abstract: 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.
  
  
  METHODS
  Systematic review and meta-analysis.
  
  
  METHODS
  MEDLINE, Embase, Web of Science, and Cochrane Central databases.
  
  
  METHODS
  Patients with BE and HGD or esophageal adenocarcinoma (EAC) who were referred for endoscopic evaluation and underwent EUS.
  
  
  METHODS
  EUS.
  
  
  METHODS
  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 (I(2) > 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).
  
  
  CONCLUSIONS
  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.
authors.affiliation: Division of Gastroenterology and Hepatology at Mayo Clinic, Jacksonville, Florida, USA.
authors.forename: Bashar J
authors.initials: BJ
authors.lastname: Qumseya
authors.affiliation: Division of Gastroenterology and Hepatology, Veterans Affairs Medical Center and University of Kansas Medical Center, Kansas City, Missouri, USA.
authors.forename: Jessica
authors.initials: J
authors.lastname: Brown
authors.affiliation: Division of Gastroenterology and Hepatology at Mayo Clinic, Jacksonville, Florida, USA.
authors.forename: Merna
authors.initials: M
authors.lastname: Abraham
authors.affiliation: Sections of Health Services Research & Gastroenterology and Hepatology, Baylor College of Medicine and Michael E. DeBakey VA, Houston, Texas, USA.
authors.forename: Donna
authors.initials: D
authors.lastname: White
authors.affiliation: Division of Gastroenterology and Hepatology at Mayo Clinic, Jacksonville, Florida, USA.
authors.forename: Herbert
authors.initials: H
authors.lastname: Wolfsen
authors.affiliation: Loyola University Health System, Maywood, Illinois, USA.
authors.forename: Neil
authors.initials: N
authors.lastname: Gupta
authors.affiliation: Sections of Health Services Research & Gastroenterology and Hepatology, Baylor College of Medicine and Michael E. DeBakey VA, Houston, Texas, USA.
authors.forename: Prashanth
authors.initials: P
authors.lastname: Vennalaganti
authors.affiliation: Sections of Health Services Research & Gastroenterology and Hepatology, Baylor College of Medicine and Michael E. DeBakey VA, Houston, Texas, USA.
authors.forename: Prateek
authors.initials: P
authors.lastname: Sharma
authors.affiliation: Division of Gastroenterology and Hepatology at Mayo Clinic, Jacksonville, Florida, USA.
authors.forename: Michael B
authors.initials: MB
authors.lastname: Wallace
mesh_terms: D000230:Adenocarcinoma / Q000000981:diagnostic imaging* / Q000473:pathology*; D001471:Barrett Esophagus / Q000000981:diagnostic imaging* / Q000473:pathology*; D002471:Cell Transformation, Neoplastic; D019160:Endosonography; D004938:Esophageal Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology*; D006801:Humans; D009367:Neoplasm Staging; D011237:Predictive Value of Tests