Efficacy and Durability of Radiofrequency Ablation for Barrett's Esophagus: Systematic Review and Meta-analysis

• Published in: Clinical gastroenterology and hepatology Vol. 11; no. 10; pp. 1245 - 1255
• Main Authors: Orman, Eric S, Li, Nan, Shaheen, Nicholas J
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01-10-2013
• Subjects: Barrett Esophagus - surgery; Catheter Ablation - adverse effects; Catheter Ablation - methods; Endoscopy; Esophageal Cancer; Gastroenterology and Hepatology; Gastroesophageal Reflux; Humans; Prevention; Recurrence; Treatment Outcome; RR; RCT; BE; CE-D; RFA; low-grade dysplasia; risk ratio; Prevention; complete eradication of dysplasia; Barrett's esophagus; endoscopic mucosal resection; Endoscopy; high-grade dysplasia; NDBE; IMC; HGD; IM; AIM; CI; EAC; complete eradication of intestinal metaplasia; LGD; nondysplastic Barrett's esophagus; Gastroesophageal Reflux; EMR; randomized controlled trial; esophageal adenocarcinoma; intestinal metaplasia; Esophageal Cancer; confidence interval; intramucosal carcinoma; radiofrequency ablation; Ablation of Intestinal Metaplasia; CE-IM
• ISSN: 1542-3565; 1542-7714
• DOI: 10.1016/j.cgh.2013.03.039

Background & Aims In patients with Barrett's esophagus (BE), radiofrequency ablation (RFA) safely and effectively eradicates dysplasia and intestinal metaplasia. We aimed to determine the efficacy and durability of RFA for patients with dysplastic and nondysplastic BE. Methods We performed a systematic review and meta-analysis of studies identified in PubMed and EMBASE that reported the proportion of patients treated with RFA who had complete eradication of dysplasia (CE-D) and intestinal metaplasia (CE-IM), and the proportion of patients with recurrent IM after successful treatment. Pooled estimates of CE-D, CE-IM, IM recurrence, and adverse events were calculated. Results We identified 18 studies of 3802 patients reporting efficacy and 6 studies of 540 patients reporting durability. Ten were prospective cohort studies, 9 were retrospective cohort studies, and 1 was a randomized trial. CE-IM was achieved in 78% of patients (95% confidence interval [CI], 70%–86%) and CE-D was achieved in 91% (95% CI, 87%–95%). After eradication, IM recurred in 13% (95% CI, 9%–18%). Progression to cancer occurred in 0.2% of patients during treatment and in 0.7% of those after CE-IM. Esophageal stricture was the most common adverse event and was reported in 5% of patients (95% CI, 3%–7%). Confidence in most summary estimates was limited by a high degree of heterogeneity, which did not appear to be caused by single outlier studies. Conclusions Treatment of BE with RFA results in CE-D and CE-IM in a high proportion of patients, with few recurrences of IM after treatment and a low rate of adverse events. Despite the large amount of study heterogeneity, these data provide additional information for patients and providers to make informed treatment decisions.