Systematic review and meta-analysis of the effectiveness of radiofrequency ablation in low grade dysplastic Barrett’s esophagus

Endoscopy ◽  
2018 ◽  
Vol 50 (10) ◽  
pp. 953-960 ◽  
Author(s):  
Gargi Pandey ◽  
Mubashir Mulla ◽  
Wyn Lewis ◽  
Antonio Foliaki ◽  
David Chan
Keyword(s):  
Systematic Review ◽  
Radiofrequency Ablation ◽  
Barrett’S Esophagus ◽  
Barrett's Esophagus ◽  
Meta Analysis ◽  
Low Grade ◽  
Short Term ◽  
Recurrence Rates ◽  
Premalignant Condition

Abstract Background Barrett’s esophagus (BE) is a premalignant condition characterized by replacement of the esophageal lining with metastatic columnar epithelium, and its management when complicated by low grade dysplasia (LGD) is controversial. This systematic review and meta-analysis aimed to determine the efficacy of radiofrequency ablation (RFA) in patients with LGD. Methods MEDLINE, EMBASE, and Web of Science were searched for studies including patients with BE-associated LGD receiving RFA (January 1990 to May 2017). The outcome measures were complete eradication of intestinal metaplasia (CE-IM) and dysplasia (CE-D), rates of progression to high grade dysplasia (HGD) or cancer, and recurrence. Results Eight studies including 619 patients with LGD (RFA = 404, surveillance = 215) were analyzed. After a median follow-up of 26 months (range 12 – 44 months), the overall pooled rates of CE-IM and CE-D after RFA were 88.17 % (95 % confidence interval [CI] 88.13 % – 88.20 %; P < 0.001) and 96.69 % (95 %CI 96.67 % – 96.71 %; P < 0.001), respectively. When compared with surveillance, RFA resulted in significantly lower rates of progression to HGD or cancer (odds ratio [OR] 0.07, 95 %CI 0.02 – 0.22). The pooled recurrence rates of IM and dysplasia were 5.6 % (95 %CI 5.57 – 5.63; P < 0.001) and 9.66 % (95 %CI 9.61 – 9.71; P < 0.001), respectively. Conclusions RFA safely eradicates IM and dysplasia and reduces the rates of progression from LGD to HGD or cancer in the short term.

scholarly journals Outcomes of Radiofrequency ablation vs endoscopic surveillance for Barrett's esophagus with low-grade dysplasia: A systematic review and meta-analysis

2021 ◽  
Author(s):  
Jagpal Singh Klair ◽  
Yousuf Zafar ◽  
Navroop Nagra ◽  
Arvind R. Murali ◽  
Mahendran Jayaraj ◽  
...  
Keyword(s):  
Systematic Review ◽  
Radiofrequency Ablation ◽  
Barrett’S Esophagus ◽  
Comparative Studies ◽  
Barrett's Esophagus ◽  
Meta Analysis ◽  
Endoscopic Surveillance ◽  
Low Grade ◽  
Risk Of Progression ◽  
Low Grade Dysplasia

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

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 ◽  
2019 ◽  
Vol 51 (07) ◽  
pp. 665-672 ◽  
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.

scholarly journals DIAGNOSIS, TREATMENT AND FOLLOW-UP OF BARRETT’S ESOPHAGUS: A SYSTEMATIC REVIEW

2020 ◽  
Vol 57 (3) ◽  
pp. 289-295
Author(s):  
José Roberto ALVES ◽  
Fabrissio Portelinha GRAFFUNDER ◽  
João Vitor Ternes RECH ◽  
Caique Martins Pereira TERNES ◽  
Iago KOERICH-SILVA
Keyword(s):  
Systematic Review ◽  
Randomized Controlled Trials ◽  
Barrett’S Esophagus ◽  
Barrett's Esophagus ◽  
Endoscopic Surveillance ◽  
Controlled Trials ◽  
Low Grade ◽  
Randomized Controlled ◽  
Mesh Terms

ABSTRACT BACKGROUND: Barrett’s esophagus (BE) is a premalignant condition that raises controversy among general practitioners and specialists, especially regarding its diagnosis, treatment, and follow-up protocols. OBJECTIVE: This systematic review aims to present the particularities and to clarify controversies related to the diagnosis, treatment and surveillance of BE. METHODS: A systematic review was conducted on PubMed, Cochrane, and SciELO based on articles published in the last 10 years. PRISMA guidelines were followed and the search was made using MeSH and non-MeSH terms “Barrett” and “diagnosis or treatment or therapy or surveillance”. We searched for complete randomized controlled clinical trials or Phase IV studies, carried out with individuals over 18 years old. RESULTS: A total of 42 randomized controlled trials were selected after applying all inclusion and exclusion criteria. A growing trend of alternative and safer techniques to traditional upper gastrointestinal endoscopy were identified, which could improve the detection of BE and patient acceptance. The use of chromoendoscopy-guided biopsy protocols significantly reduced the number of biopsies required to maintain similar BE detection rates. Furthermore, the value of BE chemoprophylaxis with esomeprazole and acetylsalicylic acid was relevant, as well as the establishment of protocols for the follow-up and endoscopic surveillance of patients with BE based predominantly on the presence and degree of dysplasia, as well as on the length of the follow-up affected by BE. CONCLUSION: Although further studies regarding the diagnosis, treatment and follow-up of BE are warranted, in light of the best evidence presented in the last decade, there is a trend towards electronic chromoendoscopy-guided biopsies for the diagnosis of BE, while treatment should encompass endoscopic techniques such as radiofrequency ablation. Risks of ablative endoscopic methods should be weighted against those of resective surgery. It is also important to consider lifetime endoscopic follow-up for both short and long term BE patients, with consideration to limitations imposed by a range of comorbidities. Unfortunately, there are no randomized controlled trials that have evaluated which is the best recommendation for BE follow-up and endoscopic surveillance (>1 cm) protocols, however, based on current International Guidelines, it is recommended esophagogastroduodenoscopy (EGD) every 5 years in BE without dysplasia with 1 up to 3 cm of extension; every 3 years in BE without dysplasia with >3 up to 10 cm of extension, every 6 to 12 months in BE with low grade dysplasia and, finally, EGD every 3 months after ablative endoscopic therapy in cases of BE with high grade dysplasia.

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