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

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