Staging laparoscopy in esophagogastric junction cancer: Systematic review and meta-analysis

Table 13 Certainty of evidence assessment (Grading of Recommendations, Assessment, Development and Evaluation)

Outcome	Number of studies	Patients (n)	Estimated effect	Certainty of evidence (GRADE)	Comments
Positive peritoneal carcinomatosis	18	1591	13% (95%CI: 10-17)	Low	High heterogeneity (I2 > 80%), moderate risk of bias
Hepatic metastatic disease	6	434	9% (95%CI: 4-14)	Low	High heterogeneity, small number of studies
Positive peritoneal malignancy	15	1453	19% (95%CI: 14-24)	Low	Variable results, wide confidence intervals, potential publication bias
Overall diagnostic performance of staging laparoscopy	18	1591	22% (95%CI: 17-27)	Low to moderate	High I2, majority observational studies, moderate risk of bias
Diagnostic performance - Siewert I	4	-	18% (95%CI: 8-28)	Low	High heterogeneity, one outlier study
Diagnostic performance - Siewert II	3	-	13% (95%CI: 8-18)	Moderate	Consistent results across studies, no heterogeneity
Positive peritoneal malignancy Siewert I	3	-	7% (95%CI: 1-12)	Low	Very heterogeneous, low frequency of events, wide CI
Positive peritoneal malignancy Siewert II	2	-	11% (95%CI: 5-18)	Moderate	Few studies, but consistent and homogeneous results

CI: Confidence interval; GRADE: Grading of Recommendations, Assessment, Development and Evaluation.