Impact of surgical vs medical management on histologic outcomes in Barrett’s esophagus: A meta-analysis

Table 1 Quality assessment of the included studies

Ref.	Country	Type of study	Cases (patients)	Selection (1-4)	Comparability (5)	Outcomes (6-8)	Total score	Assessment
Gurski et al[24]	United States	Retrospective	91; 77 ST (Nissen 61, Collis 14, Toupet 2); 14 MT	4	1	2	7	High
Rossi et al[26]	Italy	Prospective	35; 16 ST (Nissen); 19 MT	4	1	2	7	High
Zaninotto et al[18]	Italy	Prospective	89; 45 ST (43 Nissen, 1 Collis, 1 Toupet); 44 MT	4	1	2	7	High
Tolone et al[27]	Italy	Prospective	62; 37 ST (Nissen); 25 MT	4	1	2	7	High
Markar et al[25]	England	Retrospective	786; 166 ST; 620 MT	4	2	3	9	High
Szachnowicz et al[5]	Brazil	Prospective	398; 190 ST (Nissen); 207 MT	4	2	2	8	High

Numbers indicate the Newcastle-Ottawa Scale items fulfilled by each study: 1-4 correspond to the selection domain, 5 to the comparability domain, and 6-8 to the outcome domain. Higher total scores indicate better methodological quality. MT: Medical therapy; ST: Surgical treatment.

Table 2 Data from included studies, n (%)

Ref.	Study design	EGD protocol	Patients (n)	PPI	Surgery	PPI and BD	Surg and BD	F/U (months)	EGD at F/U	PPI	Surgery	REG PPI	REG surgery (n)	PROG (overall) PPI	PROG (overall) surgery	PROG HGD/EAC PPI	PROG HGD/EAC surgery
Gurski et al[24]	Retrospective cohort	Seattle	91	-	Nissen (61), Toupet (2), Collis Belsey (14)	14 (13 ND/1 LGD)	77 (52 ND/25 LGD)	50.3	At least two, spaced 6 months apart	14	77	1	28	1	8	1	3
Markar et al[25]	Retrospective cohort	-	786	Esomeprazole/omeprazole/pantoprazole 40 mg or lansoprazole 30 mg daily, ≥ 1 year	-	6201	1661	69.6	-	620	166	N/A	N/A	18	3	18	3
Rossi et al[26]	Prospective cohort	Seattle	35	Omeprazole 20 mg, twice daily	Nissen	19 LGD	16 LGD	18	At 6 months and 18 months	19	16	12	15	N/A	N/A	N/A	N/A
Szachnowicz et al[5]	Prospective cohort	Seattle	370	Omeprazole 20-80 mg daily	Nissen	1902	1802	80	Every 24 months	190	180	64	122	80	24	14	4
Tolone et al[27]	Prospective cohort	Seattle	62	Esomeprazole 40 mg, twice daily	Nissen	25 (12 ND/13 LGD)	37 (17 ND/20 LGD)	34	First and last EGD	25	37	15	34	2	0	2	0
Zaninotto et al[18]	Prospective cohort	Seattle	89	Esomeprazole/pantoprazole 40 mg or lansoprazole 30 mg or rabeprazole/omeprazole 20 mg	Nissen (43), Toupet (1), Collis Nissen (1)	44 ND	45 ND	34	First and last EGD	44	25	4	8	N/A	N/A	N/A	N/A
Total								66.1		912	521	96 (32.8)	207 (58.3)	101 (11.8)	35 (7.6)	35 (4.12)	10 (2.17)

¹Did not detail the presence or absence of dysplasia in the initial evaluation.

²Patients with low-grade dysplasia not included in the initial evaluation.

EGD: Esophagogastroduodenoscopy; PPI: Proton pump inhibitor; BD: Baseline dysplasia; ND: Non-dysplastic; LGD: Low-grade dysplasia; HGD: High-grade dysplasia; EAC: Esophageal adenocarcinoma; F/U: Follow-up; REG: Regression; PROG: Progression; N/A: Not applicable.