Faculty of 1000 evaluation for Efficacy and durability of radiofrequency ablation for Barrett's esophagus: systematic review and meta-analysis.

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.

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

Digestive Diseases ◽

10.1159/000514786 ◽

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

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