Endoscopy 2018; 50(10): 953-960
DOI: 10.1055/a-0588-5151
Original article
© Georg Thieme Verlag KG Stuttgart · New York

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

Gargi Pandey
Department of Surgery, University Hospital of Wales, Cardiff, UK
,
Mubashir Mulla
Department of Surgery, University Hospital of Wales, Cardiff, UK
,
Wyn G. Lewis
Department of Surgery, University Hospital of Wales, Cardiff, UK
,
Antonio Foliaki
Department of Surgery, University Hospital of Wales, Cardiff, UK
,
David S. Y. Chan
Department of Surgery, University Hospital of Wales, Cardiff, UK
› Author Affiliations
Further Information

Publication History

submitted 05 November 2017

accepted after revision 23 February 2018

Publication Date:
24 April 2018 (eFirst)

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.

Figs. e8 – e13, Appendix e1