Evidence map›Paper›PMID 34008109›Full record

SynthesisSurgical endoscopy2022

Fundoplication is superior to medical therapy for Barrett's esophagus disease regression and progression: a systematic review and meta-analysis.

H Wilson, V Mocanu, W Sun, J Dang, U Jogiat, J Kung, N Switzer, C Wong, S Karmali

Abstract readMeta-AnalysisSystematic Review
PubMed Publisher
In one paragraph

Synthesis in Surgical endoscopy, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 6 papers.

0numbers the graph read from it
0cells of the map it votes in
6citing papers in PubMed
2.1field-weighted citation impact, top 13% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

6 citing papers in PubMed, 15 citations in OpenAlex.

  1. The Impact of Hiatus Hernia Size on Dysplasia Progression in Patients With Barrett's Esophagus.JGH open : an open access journal of gastroenterology and hepatology · 2026
    Article
  2. Article
  3. Review
  4. Article
  5. Unmet needs in Barret's esophagus diagnosis and treatment: a narrative review.Translational gastroenterology and hepatology · 2023
    Review
  6. LAPAROSCOPIC ANTIREFLUX SURGERY: ARE OLD QUESTIONS ANSWERED? SHOULD IT BE USED CONJOINED WITH ENDOSCOPIC THERAPY FOR BARRETT'S ESOPHAGUS?Arquivos brasileiros de cirurgia digestiva : ABCD = Brazilian archives of digestive surgery · 2022
    Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

9 authors at 1 institution in 1 country.

H WilsonFaculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada.
V MocanuDepartment of Surgery, University of Alberta, Edmonton, AB, Canada. Vmocanu1987@gmail.com.ORCID 0000-0001-7855-6242
W SunDepartment of Surgery, University of Alberta, Edmonton, AB, Canada.
J DangDepartment of Surgery, University of Alberta, Edmonton, AB, Canada.
U JogiatDepartment of Surgery, University of Alberta, Edmonton, AB, Canada.
J KungJohn W. Scott Health Sciences Library, University of Alberta, Edmonton, AB, Canada.
N SwitzerDepartment of Surgery, University of Alberta, Edmonton, AB, Canada.
C WongDivision of Gastroenterology, University of Alberta, Edmonton, AB, Canada.
S KarmaliDepartment of Surgery, University of Alberta, Edmonton, AB, Canada.
University of Alberta · CA

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundFundoplication and medical management are current mainstays for management of Barrett's esophagus (BE), however our understanding of differences in outcomes between these two treatments is limited. The aim of this study was to perform a systematic review and meta-analysis to evaluate the efficacy of these interventions on BE disease regression and progression. METHODS AND PROCEDURES: A comprehensive search in MEDLINE, EMBASE, Scopus, Web of Science, and Cochrane Library databases was performed on February 22, 2021. Inclusion criteria were studies with both medical and surgical management comparators, BE diagnosis prior to treatment, patients aged ≥ 18 years, and studies with greater than five patients. Primary outcomes of interest included evaluating changes in histopathologic BE regression and disease progression between interventions. Meta-analysis was performed using a Mantel-Haenszel random-effects model (RevMan 5.4.1).

resultsA total of 7231 studies were retrieved after initial search with nine studies (1 randomized trial, 7 prospective cohorts, 1 retrospective cohort) meeting final inclusion criteria. Of included studies, 890 (65%) patients received medical management while 470 (35%) received surgical management. Medical management included proton pump inhibitors (n = 807, 91%; 6 studies), H2-receptor blockers (n = 40, 4% patients; 3 studies), and combination therapy (n = 43, 5%; 1 study). Nissen fundoplication was the most commonly performed type of fundoplication (n = 265, 93%). Median length of follow-up ranged from 1.5-7 years. Meta-analysis revealed that fundoplication was associated with improved histopathologic regression of metaplasia/low-grade dysplasia (OR 4.38; 95% CI 2.28-8.42; p < 0.00001) and disease progression to dysplasia/adenocarcinoma (OR 0.34; 95% CI 0.12-0.96; p = 0.04) compared to medical therapy.

conclusionFundoplication is superior to medical therapy with regards to improved odds of histopathologic BE disease regression and disease progression. Additional randomized trials which directly compare medical management and surgical intervention are required to delineate the optimal delivery and timing of these interventions.

Indexed as

Barrett EsophagusEsophageal NeoplasmsGastroesophageal RefluxDisease ProgressionFundoplicationHumansProspective StudiesRandomized Controlled Trials as TopicRetrospective StudiesBarrett’s esophagusDysplasiaFundoplicationProton pump inhibitors

Identifiers

PMID34008109
OpenAlexW3161629052

What OpenQuestion holds

Textmetadata
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.