Table 8.

Grading of Recommendations Assessment, Development and Evaluation Evidence Profile for PICO Question 4: Comparing resection of visible lesions followed by ablation of the remaining BE segment with resection of the entire BE segment.

Certainty assessment							№ of patients		Effect		Certainty	Importance
№ of studies	Study design	Risk of bias	Inconsistency	Indirectness	Imprecision	Other considerations	sEMR	fEMR+RFA	Relative (95% CI)	Absolute (95% CI)
EAC at 1-2 yrs (only 3 studies had follow up of more than 3 yrs); single arm comparison: sEMR (11 observational studies) vs. fEMR + RFA (9 observational studies)
20a	observational studies	seriousb	not serious	not serious	very seriousc	publication bias strongly suspectedd	10/701 (1.4%)	12/702 (1.7%)	RR 0.83 (0.36 to 1.92)	3 fewer per 1,000 (from 11 fewer to 16 more)	⨁◯◯◯ Very low	CRITICAL
Complete eradication of neoplasia at 1-2 yrs (only 3 studies had follow up of more than 3 yrs) indirect comparison: sEMR (11 observational studies) vs. fEMR + RFA (9 observational studies)
20a	observational studies	seriousb	not serious	seriouse	not serious	publication bias strongly suspectedd	717/774 (92.6%)	699/747 (93.6%)	OR 1.33 (0.56 to 3.15)	15 more per 1,000 (from 45 fewer to 43 more)	⨁◯◯◯ Very low	CRITICAL
Stricture
52f	observational studies	seriousg	not serioush	not serious	not serious	none	269/840 (32.0%)	585/13882 (4.2%)	RR 7.33 (6.46 to 8.31)	267 more per 1,000 (from 230 more to 308 more)	⨁◯◯◯ Very low	CRITICAL
Bleeding
32i	observational studies	seriousb	not serioush	not serious	seriousj	none	59/840 (7.0%)	53/5902 (0.9%)	RR 7.82 (5.44 to 11.25)	61 more per 1,000 (from 40 more to 92 more)	⨁◯◯◯ Very low	CRITICAL
Perforation
40k	observational studies	seriousb	not serious	not serious	seriousj	none	13/840 (1.5%)	16/5799 (0.3%)	RR 5.62 (2.72 to 11.65)	13 more per 1,000 (from 5 more to 29 more)	⨁◯◯◯ Very low	CRITICAL

^a.sEMR (11 observational studies) vs. fEMR + RFA (9 observational studies)

^b.Comparison of independent single arm studies with no time concurrent controls

^c.Very small event number in both treatment groups

^d.Publication bias was noted by Desai et al using Eggers regression test for the sEMR studies

^e.Indirectness suspected since the outcome is eradication of dysplasia and not recurrence of cancer or mortality from cancer

^f.sEMR (12 observational studies) vs. fEMR + RFA (40 observational studies)

^g.Comparison of independent single arm studies with no time concurrent controls. Additionally the sEMR intervention was not standardized and differed between studies; some studies had less resections per procedure and used steroid, while other studies had more resections per procedure.

^h.Cannot assess for inconsistency because 2 treatment interventions are pooled from a single arm studies, but there was heterogeneity observed when the pooled estimate was calculate for each intervention separately.

^i.sEMR (12 observational studies) vs. fEMR + RFA (20 observational studies)

^j.low event number

^k.sEMR (12 observational studies) vs. fEMR + RFA (28 observational studies)