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Systematic review comparing radiofrequency ablation and complete endoscopic resection in treating dysplastic Barrett's esophagus: a critical assessment of histologic outcomes and adverse events.

Abstract：

BACKGROUND:With recent advances in endoscopy, endoscopic techniques have surpassed esophagectomy in the treatment of dysplastic Barrett's esophagus (BE). OBJECTIVE:To compare the efficacy and safety of complete EMR and radiofrequency ablation (RFA) in the treatment of dysplastic BE. DESIGN:Systematic review of literature. PATIENTS:Diagnosis of BE with high-grade dysplasia or intramucosal cancer. INTERVENTION:Complete EMR or RFA. MAIN OUTCOME MEASUREMENTS:Complete eradication of dysplasia and intestinal metaplasia at the end of treatment and after >12 months' follow-up. Adverse event rates associated with treatment. RESULTS:A total of 22 studies met the inclusion criteria. Only 1 trial directly compared the 2 techniques; most studies were observational case series. Dysplasia was effectively eradicated at the end of treatment in 95% of patients after complete EMR and 92% after RFA. After a median follow-up of 23 months for complete EMR and 21 months for RFA, eradication of dysplasia was maintained in 95% of patients treated with complete EMR and 94% treated with RFA. Short-term adverse events were seen in 12% of patients treated with complete EMR but in only 2.5% of those treated with RFA. Esophageal strictures were adverse events in 38% of patients treated with complete EMR, compared with 4% of those treated with RFA. Progression to cancer appeared to be rare after treatment, although follow-up was short. LIMITATIONS:Small studies, heterogeneous in design, with variable outcome measures. Also follow-up durations were short, limiting evaluation of long-term durability of both treatments. CONCLUSION:RFA and complete EMR are equally effective in the short-term treatment of dysplastic BE, but adverse event rates are higher with complete EMR.

journal_name

Gastrointest Endosc

journal_title

Gastrointestinal endoscopy

authors

Chadwick G,Groene O,Markar SR,Hoare J,Cromwell D,Hanna GB

doi

10.1016/j.gie.2013.11.030

subject

Has Abstract

pub_date

2014-05-01 00:00:00

pages

718-731.e3

issue

5

eissn

0016-5107

issn

1097-6779

pii

S0016-5107(13)02626-6

journal_volume

79

pub_type

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