Open AccessOutcomes of Radiofrequency Ablation versus Endoscopic Surveillance for Barrett’s Esophagus with Low-Grade Dysplasia: A Systematic Review and Meta-Analysis
Author(s) -
Jagpal S. Klair,
Yousaf Zafar,
Navroop Nagra,
Arvind R. Murali,
Mahendran Jayaraj,
Dhruv Singh,
Tarun Rustagi,
Rajesh Krishnamoorthi
Publication year - 2021
Publication title -
digestive diseases
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.879
H-Index - 66
eISSN - 1421-9875
pISSN - 0257-2753
DOI - 10.1159/000514786
Subject(s) - medicine , barrett's esophagus , dysplasia , radiofrequency ablation , meta analysis , esophagus , confidence interval , gastroenterology , intestinal metaplasia , endoscopic mucosal resection , endoscopy , adenocarcinoma , ablation , cancer
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 versus 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 versus 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 versus 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% confidence interval [CI]: 0.04–0.65, p = 0.01). The progression to HGD alone was significantly lower in patients treated with RFA versus endoscopic surveillance (OR: 0.23, 95% CI: 0.08–0.61, p = 0.003). The progression to EAC alone was numerically lower in RFA than 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.