ASGE Technology Committee systematic review and meta-analysis assessing the ASGE Preservation and Incorporation of Valuable Endoscopic Innovations thresholds for adopting real-time imaging–assisted endoscopic targeted biopsy during endoscopic surveillance of Barrett’s esophagus

BACKGROUND: Endoscopic therapy using radiofrequency ablation (RFA) is a recommended treatment for Barrett’s esophagus with high grade dysplasia (BE-HGD) without a visible lesion which is managed by resection. However, currently there is no consensus on the management of BE with low grade dysplasia (BE-LGD) – RFA vs endoscopic surveillance. Hence, we performed a systematic review and meta-analysis of these comparative studies to compare the risk of progression to HGD or esophageal adenocarcinoma (EAC) among patients with BE-LGD treated with RFA vs endoscopic surveillance. METHODS: The primary outcome was to compare the risk of progression to HGD or EAC among patients with BE-LGD treated with RFA vs endoscopic surveillance. RESULTS: Four comparative studies reporting a total of 543 patients with BE-LGD were included in the meta-analysis (234 in RFA and 309 in endoscopic surveillance). The progression of BE-LGD to either HGD or EAC was significantly lower in patients treated with RFA compared to endoscopic surveillance (OR: 0.17, 95% CI: 0.04-0.65, p=0.01). The progression to HGD alone was significantly lower in patients treated with RFA vs endoscopic surveillance (OR: 0.23, 95% CI: 0.08-0.61, p=0.003). The progression to EAC alone was numerically lower in RFA compared to endoscopic surveillance without statistical significance (OR: 0.44, 95% CI: 0.17-1.16, p=0.09). Moderate heterogeneity was noted in the analysis. CONCLUSIONS: Based on our meta-analysis, there was a significant reduction in the risk of progression to HGD or EAC among patients with BE-LGD treated with RFA compared with those undergoing endoscopic surveillance. Endoscopic eradication therapy with RFA should be the preferred management approach for BE-LGD

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The Effect of Endoscopic Surveillance in Patients With Barrett’s Esophagus: A Systematic Review and Meta-analysis

Gastroenterology ◽

10.1053/j.gastro.2018.02.022 ◽

2018 ◽

Vol 154 (8) ◽

pp. 2068-2086.e5 ◽

Cited By ~ 46

Author(s):

Don Chamil Codipilly ◽

Apoorva Krishna Chandar ◽

Siddharth Singh ◽

Sachin Wani ◽

Nicholas J. Shaheen ◽

...

Keyword(s):

Systematic Review ◽

Barrett’S Esophagus ◽

Barrett's Esophagus ◽

Meta Analysis ◽

Endoscopic Surveillance

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Faculty Opinions recommendation of Helicobacter pylori infection and Barrett's esophagus: a systematic review and meta-analysis.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.14099956.793519558 ◽

2016 ◽

Author(s):

Milli Gupta

Keyword(s):

Systematic Review ◽

Helicobacter Pylori ◽

Barrett’S Esophagus ◽

Barrett's Esophagus ◽

Meta Analysis ◽

Helicobacter Pylori Infection

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Faculty Opinions recommendation of Statins are associated with reduced risk of esophageal cancer, particularly in patients with Barrett's esophagus: a systematic review and meta-analysis.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.717976589.793509592 ◽

2015 ◽

Author(s):

Pagona Lagiou

Keyword(s):

Systematic Review ◽

Esophageal Cancer ◽

Barrett’S Esophagus ◽

Barrett's Esophagus ◽

Meta Analysis ◽

Reduced Risk

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Sa1833 Incremental Benefit of Computer-Assisted Brush-Biopsy (WATS3D) Compared to Standard Endoscopic Biopsy for Detection of Barrett's Esophagus (BE) and Dysplasia: Systematic Review and Meta-Analysis

Gastroenterology ◽

10.1016/s0016-5085(14)61102-1 ◽

2014 ◽

Vol 146 (5) ◽

pp. S-307 ◽

Cited By ~ 1

Author(s):

Lauren B. Gerson ◽

Mark Rutenberg ◽

Richard Scott

Keyword(s):

Systematic Review ◽

Barrett’S Esophagus ◽

Barrett's Esophagus ◽

Meta Analysis ◽

Endoscopic Biopsy ◽

Computer Assisted ◽

Brush Biopsy ◽

Incremental Benefit

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Post Endoscopy Barrett’s Neoplasia (PEBN) After A Negative Index Endoscopy: A Systematic Review & Proposal For Definitions and Performance Measures in Endoscopy

Endoscopy ◽

10.1055/a-1729-8066 ◽

2022 ◽

Author(s):

Madhav Desai ◽

David A Lieberman ◽

Sachin Srinivasan ◽

Venkat Nutalapati ◽

Abhishek Challa ◽

...

Keyword(s):

Systematic Review ◽

Barrett’S Esophagus ◽

Barrett's Esophagus ◽

Meta Analysis ◽

Incidence Rates ◽

High Rate ◽

Negative Index ◽

Inclusion Criteria ◽

Surveillance Interval ◽

And Performance

Background and aims: A high rate of neoplasia (high grade dysplasia; HGD and esophageal adenocarcinoma; EAC) has been reported in Barrett’s Esophagus at index endoscopy but precise rates of post endoscopy Barrett’s neoplasia (PEBN) are unknown. Methods: Systematic review and meta-analysis was performed examining electronic databases (inception to October 2021) for studies reporting PEBN. Consistent with definitions of Post Colonoscopy Colorectal Cancer as proposed by the World Endoscopy Organization, we defined neoplasia(HGD/EAC) detected at index endoscopy and/or within 6 months of a negative index endoscopy as “prevalent” neoplasia; those detected after 6 months of a negative index endoscopy and prior to next surveillance interval(i.e. 3 years) as PEBN or “interval” neoplasia, and those detected after 36 months of a negative index endoscopy as “incident” neoplasia. Pooled incidence rates and proportion relative to total neoplasia were analyzed. Results: 11 studies (n=59,795, age:62.3±3.3 years, 61%males) met inclusion criteria. The pooled incidence rates were: prevalent neoplasia 4.5% (95%confidence interval: 2.2-8.9) at baseline and additional 0.3%(0.1-0.7) within first 6 months, PEBN 0.52%(0.48-0.58) and incident neoplasia: 1.41%(0.93-2.14). At 3 years from index endoscopy, PEBN accounted for 3% while prevalent neoplasia accounted for 97% of total Barrett’s neoplasia. Conclusion: Neoplasia detected at or within 6 months of index endoscopy account for most of the Barrett’s neoplasia(>90%). Post-Endoscopy Barrett’s Neoplasia account for ~3% of cases and can be used for validation in future. This highlights the importance of a high-quality index endoscopy in Barrett’s Esophagus and the need to establish quality benchmarks to measure endoscopists’ performance.

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Correction: Prevalence of Barrett’s esophagus in obese patients undergoing pre-bariatric surgery evaluation: a systematic review and meta-analysis

Endoscopy ◽

10.1055/a-1174-3656 ◽

2020 ◽

Vol 52 (07) ◽

pp. C8-C8

Author(s):

Bashar Qumseya ◽

Sherif Gendy ◽

Alexander Wallace ◽

Dennis Yang ◽

Davis Estores ◽

...

Keyword(s):

Systematic Review ◽

Bariatric Surgery ◽

Barrett’S Esophagus ◽

Barrett's Esophagus ◽

Meta Analysis ◽

Obese Patients

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Liquid Nitrogen Spray Cryotherapy in Treatment of Barrett's Esophagus, where do we stand? A Systematic Review and Meta-Analysis

Diseases of the Esophagus ◽

10.1093/dote/doy130 ◽

2019 ◽

Vol 32 (6) ◽

Cited By ~ 3

Author(s):

B P Mohan ◽

R Krishnamoorthi ◽

S Ponnada ◽

M Shakhatreh ◽

M Jayaraj ◽

...

Keyword(s):

Systematic Review ◽

Barrett’S Esophagus ◽

Liquid Nitrogen ◽

Barrett's Esophagus ◽

Meta Analysis

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Significantly lower annual rates of neoplastic progression in short- compared to long-segment non-dysplastic Barrett’s esophagus: a systematic review and meta-analysis

Endoscopy ◽

10.1055/a-0869-7960 ◽

2019 ◽

Vol 51 (07) ◽

pp. 665-672 ◽

Cited By ~ 8

Author(s):

Viveksandeep Thoguluva Chandrasekar ◽

Nour Hamade ◽

Madhav Desai ◽

Tarun Rai ◽

Venkata Subhash Gorrepati ◽

...

Keyword(s):

Systematic Review ◽

Barrett’S Esophagus ◽

Barrett's Esophagus ◽

Meta Analysis ◽

Significant Heterogeneity ◽

Neoplastic Progression ◽

Number Of Patients ◽

The Mean ◽

Surveillance Endoscopy

Abstract Background Although shorter lengths of Barrett’s esophagus (BE) have been associated with a lower risk of neoplastic progression, precise estimates have varied, especially for non-dysplastic BE (NDBE) only. Therefore, current US guidelines do not provide specific recommendations on surveillance intervals based on BE length. We performed a systematic review and meta-analysis of the published literature to examine neoplastic progression rates of NDBE based on BE length. Methods PubMed, Cochrane, Google Scholar, and Embase were comprehensively searched. Studies reporting progression rates in patients with NDBE and > 1 year of follow-up were included. The number of patients progressing to esophageal adenocarcinoma (EAC) and high grade dysplasia (HGD)/EAC in individual studies and the mean follow-up were recorded to derive person-years of follow-up. Pooled rates of progression to EAC and HGD/EAC based on BE length (< 3 cm vs. ≥ 3 cm) were calculated. Results Of the 486 initial studies identified, 10 met the inclusion/exclusion criteria. These included a total of 4097 NDBE patients; 1979 with short-segment BE (SSBE; 10 773 person-years of follow-up) and 2118 with long-segment BE (LSBE; 12 868 person-years). The annual rates of progression to EAC were significantly lower for SSBE compared with LSBE: 0.06 % (95 % confidence interval 0.01 % – 0.10 %) vs. 0.31 % (0.21 % – 0.40 %), respectively; odds ratio (OR) 0.25 (0.11 – 0.56); P < 0.001, as were the rates for the combined endpoint (HGD/EAC): 0.24 % (0.09 % – 0.32 %) vs. 0.76 % (0.43 % – 0.89 %), respectively; OR 0.35 (0.21 – 0.58); P < 0.001. There was no significant heterogeneity among studies. Conclusion The results demonstrate significantly lower rates of neoplastic progression in NDBE patients with SSBE compared with LSBE. BE length can easily be used for risk stratification purposes for NDBE patients undergoing surveillance endoscopy and consideration should be given to tailoring surveillance intervals based on BE length in future US guidelines.

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