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    Appendix A: Methods and literature search strategy

    Methods and literature search strategy

    NICE has identified studies and reviews relevant to balloon cryoablation for Barrett's oesophagus from the medical literature.

    Search strategy design and peer review

    This search report is informed by the Preferred Reporting Items for Systematic reviews and Meta-Analyses literature search extension (PRISMA-S).

    A NICE information specialist ran the literature searches on 19/02/2025. See the search strategy history for the full search strategy for each database. Relevant published studies identified during consultation or resolution that are published after this date may also be considered for inclusion.

    The principal search strategy was developed in MEDLINE ALL (Ovid interface). It was adapted for use in each of the databases listed in table 4a, taking into account the database's size, search functionality and subject coverage. The MEDLINE ALL strategy was quality assured by a NICE senior information specialist. All translated search strategies were peer reviewed to ensure their accuracy. The quality assurance and peer review procedures were adapted from the Peer Review of Electronic Search Strategies (PRESS) 2015 evidence-based checklist.

    Review management

    The search results were managed in EPPI‑Reviewer version 5 (EPPI‑R5). Duplicates were removed in EPPI‑R5 using a 2‑step process. First, automated deduplication was done using a high-value algorithm. Second, manual deduplication was used to assess low-probability matches. All decisions about inclusion, exclusion and deduplication were recorded and stored.

    Limits and restrictions

    The CENTRAL database search removed trial registry records and conference material. The Embase search excluded conference material.

    English language limits were applied to the search when possible in the database.

    The search was limited from 26/03/2024 to 19/02/2025. The date limit was included to update searches undertaken for an earlier version of this guidance.

    The limit to remove animal studies in the searches is standard NICE practice, which has been adapted from Dickersin K, Scherer R, Lefebvre C (1994) Systematic Reviews: Identifying relevant studies for systematic reviews. BMJ 309(6964): 1286.

    Main search

    Table 4. Main search results

    Database

    Date searched

    Database platform

    Database segment or version

    Number of results downloaded

    Cochrane Central Register of Controlled Trials (CENTRAL)

    19/02/2025

    Wiley

    Issue 2 of 12, February 2025

    2

    Cochrane Database of Systematic Reviews (CDSR)

    19/02/2025

    Wiley

    Issue 2 of 12, February 2025

    0

    Embase

    19/02/2025

    Ovid

    1974 to February 18 2025

    45

    INAHTA International HTA Database

    19/02/2025

    INHTA

    -

    2

    MEDLINE ALL

    19/02/2025

    Ovid

    1946 to February 18 2025

    21

    Search strategy history

    MEDLINE ALL search strategy

    1             Barrett Esophagus/        8980

    2             (barrett* adj4 (esophag* or oesophag* or epithelium* or syndrome* or metaplas*)).tw.            10646

    3             ((columnar* or specialised* or specialized* or intestinalized* or intestinalised* or metaplas*) adj4 (epithelium* or oesophag* or esophag* or muscosa*)).tw.       6549

    4             (CELLO or CLO).tw.       6168

    5             exp Esophageal Neoplasms/    62779

    6             ((oesophag* or esophag*) adj4 (dysplas*or lesion* or neoplasm* or cancer* or carcinoma* or adenocarcinom* or tumor* or tumour* or malignan* or angiosarcoma* or leiomyosarcoma* or lump*)).tw.                71289

    7             (ESCN or ESCC).tw.       10363

    8             or/1-7   100427

    9             Cryosurgery/     14633

    10           Ablation Techniques/   3805

    11           Freezing/            26818

    12           ((balloon* or focal* or endoscop*) adj4 (cryoablat* or cryosurg* or cryotherap* or freez* or ablat*)).tw.                3748

    13           (cryoballoon* or cryo-balloon* or cryo balloon*).tw.    2021

    14           coldplay*.tw.    3

    15           or/9-14 48477

    16           8 and 15              738

    17           animals/ not humans/ 5273696

    18           16 not 17            724

    19           limit 18 to ed=20240326-20250219      16

    20           limit 18 to dt=20240326-20250219       19

    21           19 or 20               22

    22           limit 21 to english language       21

    Embase search strategy

    Embase <1974 to 2025 February 18>

    1 Barrett Esophagus/ 20572

    2 (barrett* adj4 (esophag* or oesophag* or epithelium or syndrome* or metaplas*)).tw. 18256

    3 ((columnar or specialised or specialized or intestinalized or intestinalised or metaplas*) adj3 (epithelium or oesophag* or esophag* or mucosa)).tw. 8639

    4 (CELLO or CLO).tw. 4973

    5 exp Esophageal tumor/ 114545

    6 ((oesophag* or esophag*) adj4 (dysplas* or lesion* or neoplas* or cancer* or carcinoma* or adenocarcinom* or tumour* or tumor* or malignan* or angiosarcoma* or sarcoma* or teratoma* or blastoma* or microcytic* or carcino* or leiomyosarcoma* or lump*)).tw. 107567

    7 (ESCN or ESCC).tw. 13633

    8 or/1-7 156478

    9 Cryosurgery/ 9012

    10 Ablation Therapy/ 28425

    11 Freezing/ 36074

    12 ((balloon* or focal* or endoscop*) adj4 (cryoablat* or cryosurg* or cryotherap* or freez* or ablat*)).tw. 7021

    13 (cryoballoon* or cyro-balloon* or cryo balloon*).tw. 4125

    14 coldplay*.tw. 7

    15 or/9-14 81456

    16 8 and 15 1969

    17 nonhuman/ not human/ 5582310

    18 16 not 17 1942

    19 limit 18 to english language 1853

    20 (conference abstract* or conference review or conference paper or conference proceeding).db,pt,su. 6162273

    21 19 not 20 945

    22 limit 21 to dc=20240326-20250219 45

    23 limit 21 to dd=20240326-20250219 40

    24 22 or 23 45

    Cochrane Library (CDSR and CENTRAL) search strategy

    ID Search Hits

    #1 MeSH descriptor: [Barrett Esophagus] explode all trees 344

    #2 (barrett* near/4 (esophag* or oesophag* or epithelium* or syndrome* or metaplas*)) 827

    #3 ((columnar* or specialised* or specialized* or intestinalized* or intestinalised* or metaplas*) near/4 (epithelium* or oesophag* or esophag* or muscosa*)) 146

    #4 (CELLO or CLO) 469

    #5 MeSH descriptor: [Esophageal Neoplasms] explode all trees 2640

    #6 ((oesophag* or esophag*) near/4 (dysplas*or lesion* or neoplasm* or cancer* or carcinoma* or adenocarcinom* or tumor* or tumour* or malignan* or angiosarcoma* or leiomyosarcoma* or lump*)) 7920

    #7 (ESCN or ESCC) 582

    #8 #1 or #2 or #3 or #4 or #5 or #6 or #7 8830

    #9 MeSH descriptor: [Cryosurgery] this term only 526

    #10 MeSH descriptor: [Ablation Techniques] this term only 171

    #11 MeSH descriptor: [Freezing] this term only 152

    #12 ((balloon* or focal* or endoscop*) near/4 (cryoablat* or cryosurg* or cryotherap* or freez* or ablat*)) 668

    #13 (cryoballoon* or cryo-balloon* or cryo balloon*) 471

    #14 coldplay* 1

    #15 #9 or #10 or #11 or #12 or #13 or #14 1740

    #16 #8 AND #15 111

    #17 "conference":pt or (clinicaltrials or trialsearch):so 804706

    #18 #16 NOT #17 with Cochrane Library publication date Between Mar 2024 and Feb 2025, in Cochrane Reviews, Cochrane Protocols 0

    #19 #16 NOT #17 with Publication Year from 2024 to 2025, in Trials 2

    INAHTA HTA Database search strategy

    1 "Barrett Esophagus"[mh] 30

    2 (barrett* AND (esophag* or oesophag* or epithelium* or syndrome* or metaplas*)) 38

    3 ((columnar* or specialised* or specialized* or intestinalized* or intestinalised* or metaplas*) AND (epithelium* or oesophag* or esophag* or muscosa*)) 5

    4 (CELLO or CLO) 0

    5 "Esophageal Neoplasms"[mh] 68

    6 (oesophag* or esophag*) AND (dysplas*or lesion* or neoplasm* or cancer* or carcinoma* or adenocarcinom* or tumor* or tumour* or malignan* or angiosarcoma* or leiomyosarcoma* or lump*)) 106

    7 (ESCN or ESCC) 0

    8 #7 OR #6 OR #5 OR #4 OR #3 OR #2 OR #1 125

    9 "Cryosurgery"[mh] 30

    10 "Ablation Techniques"[mh] 35

    11 "Freezing"[mh] 1

    12 ((balloon* or focal* or endoscop*) AND (cryoablat* or cryosurg* or cryotherap* or freez* or ablat*)) 46

    13 (cryoballoon* or cryo-balloon* or cryo balloon*) 159

    14 coldplay* 0

    15 #14 OR #13 OR #12 OR #11 OR #10 OR #9 251

    16 #15 AND #8 90 Search was limited from 2024-2025 and English Language but limits do not display on the search strategy. This search yielded 2 results.

    Inclusion criteria

    The following inclusion criteria were applied to the abstracts identified by the literature search.

    • Publication type: clinical studies were included with emphasis on identifying good quality studies. Abstracts were excluded if they did not report clinical outcomes. Reviews, editorials, and laboratory or animal studies, were also excluded and so were conference abstracts, because of the difficulty of appraising study methodology, unless they reported specific adverse events not available in the published literature.

    • People with Barrett's oesophagus.

    • Intervention or test: Balloon cryoablation.

    • Outcome: articles were retrieved if the abstract contained information relevant to the safety, efficacy, or both.

    If selection criteria could not be determined from the abstracts the full paper was retrieved.

    Potentially relevant studies not included in the main evidence summary are listed in Appendix B: Other relevant studies.

    Find out more about how NICE selects the evidence for the committee.