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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 (online)

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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

 

  • References

  • 1 National Institute of Clinical Excellence. Epithelial radiofrequency ablation for Barrett's esophagus with low-grade dysplasia or no dysplasia. 2014 Available at: Accessed: 1 March 2018 https://www.nice.org.uk/guidance/ipg496
    PubMedGoogle Scholar
  • 2 Luigiano C, Iabichino G, Eusebi LH. et al. Outcomes of radiofrequency ablation for dysplastic Barrett's esophagus: a comprehensive review. Gastroenterol Res Pract 2016 2016; 4249510
    PubMedGoogle Scholar
  • 3 Jankowski J, Barr H, Wang K. et al. Diagnosis and management of Barrett's oesophagus. BMJ 2010; 341: c4551
    CrossrefPubMedGoogle Scholar
  • 4 Pophali P, Halland M. Barrett's oesophagus: diagnosis and management. BMJ 2016; 353: i2373
    PubMedGoogle Scholar
  • 5 Hvid-Jensen F, Pedersen L, Drewes AM. et al. Incidence of adenocarcinoma among patients with Barrett's esophagus. NEJM 2011; 365: 1375-1383
    CrossrefPubMedGoogle Scholar
  • 6 Bhat S, Coleman HG, Yousef F. et al. Risk of malignant progression in Barrett's esophagus patients: results from a large population-based study. J Natl Cancer Inst 2011; 103: 1049-1057
    CrossrefPubMedGoogle Scholar
  • 7 Sharma P, Falk GW, Weston AP. et al. Dysplasia and cancer in a large multicenter cohort of patients with Barrett's esophagus. Clin Gastroenterol Hepatol 2006; 4: 566-572
    CrossrefPubMedGoogle Scholar
  • 8 Tham T. BSG guidelines on the diagnosis and management of Barrett’s esophagus – 2015 update. Available from: https://www.bsg.org.uk/asset/F9A2746F-ACFC-41B4-B7DA46B96BFBCDA2 Accessed 1 March 2018
    PubMedGoogle Scholar
  • 9 Weusten B, Bisschops R, Coron E. et al. Endoscopic management of Barrett's esophagus: European Society of Gastrointestinal Endoscopy (ESGE) Position Statement. Endoscopy 2017; 49: 191-198
    Article in Thieme ConnectPubMedGoogle Scholar
  • 10 Shaheen NJ, Falk GW, Iyer PG. et al. ACG Clinical Guideline: Diagnosis and management of Barrett's esophagus. Am J Gastroenterol 2016; 111: 30-50 ; quiz 51
    CrossrefPubMedGoogle Scholar
  • 11 Moher D, Liberati A, Tetzlaff J. et al. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med 2009; 6: e1000097
    CrossrefPubMedGoogle Scholar
  • 12 Akobeng AK. Principles of evidence based medicine. Arch Dis Child 2005; 90: 837-840
    CrossrefPubMedGoogle Scholar
  • 13 Critical Appraisal Skills Programme (CASP). Randomized Controlled Trial Checklist. Available at: www.casp-uk.net/casp-tools-checklists Accessed: 1 March 2018
    PubMedGoogle Scholar
  • 14 Higgins JP, Altman DG, Gotzsche PC. et al. The Cochrane Collaboration's tool for assessing risk of bias in randomised trials. BMJ 2011; 343: d5928
    CrossrefPubMedGoogle Scholar
  • 15 Phoa KN, van Vilsteren FG, Weusten BL. et al. Radiofrequency ablation vs endoscopic surveillance for patients with Barrett esophagus and low-grade dysplasia: a randomized clinical trial. JAMA 2014; 311: 1209-1217
    CrossrefPubMedGoogle Scholar
  • 16 Shaheen NJ, Sharma P, Overholt BF. et al. Radiofrequency ablation in Barrett's esophagus with dysplasia. NEJM 2009; 360: 2277-2288
    CrossrefPubMedGoogle Scholar
  • 17 Guthikonda A, Cotton CC, Madanick RD. et al. Clinical outcomes following recurrence of intestinal metaplasia after successful treatment of Barrett's esophagus with radiofrequency ablation. Am J Gastroenterol 2017; 112: 87-94
    CrossrefPubMedGoogle Scholar
  • 18 Komanduri S, Kahrilas PJ, Krishnan K. et al. Recurrence of Barrett's esophagus is rare following endoscopic eradication therapy coupled with effective reflux control. Am J Gastroenterol 2017; 112: 556-566
    CrossrefPubMedGoogle Scholar
  • 19 Orman ES, Kim HP, Bulsiewicz WJ. et al. Intestinal metaplasia recurs infrequently in patients successfully treated for Barrett's esophagus with radiofrequency ablation. Am J Gastroenterol 2013; 108: 187-195 ; quiz 196
    CrossrefPubMedGoogle Scholar
  • 20 Haidry RJ, Dunn JM, Butt MA. et al. Radiofrequency ablation and endoscopic mucosal resection for dysplastic Barrett's esophagus and early esophageal adenocarcinoma: outcomes of the UK National Halo RFA Registry. Gastroenterology 2013; 145: 87-95
    CrossrefPubMedGoogle Scholar
  • 21 Small AJ, Araujo JL, Leggett CL. et al. Radiofrequency ablation is associated with decreased neoplastic progression in patients with Barrett's esophagus and confirmed low-grade dysplasia. Gastroenterology 2015; 149: 567-576 e563; quiz e513–e564
    CrossrefPubMedGoogle Scholar
  • 22 Sharma VK, Jae Kim H, Das A. et al. Circumferential and focal ablation of Barrett's esophagus containing dysplasia. Am J Gastroenterol 2009; 104: 310-317
    CrossrefPubMedGoogle Scholar
  • 23 Flejou JF. Barrett's oesophagus: from metaplasia to dysplasia and cancer. Gut 2005; 54 : i6-i12
    CrossrefPubMedGoogle Scholar
  • 24 Duits LC, Phoa KN, Curvers WL. et al. Barrett's oesophagus patients with low-grade dysplasia can be accurately risk-stratified after histological review by an expert pathology panel. Gut 2015; 64: 700-706
    CrossrefPubMedGoogle Scholar
  • 25 Wani S, Falk GW, Post J. et al. Risk factors for progression of low-grade dysplasia in patients with Barrett's esophagus. Gastroenterology 2011; 141: 1179-1186 , 1186 e1171
    CrossrefPubMedGoogle Scholar
  • 26 Skacel M, Petras RE, Gramlich TL. et al. The diagnosis of low-grade dysplasia in Barrett's esophagus and its implications for disease progression. Am J Gastroenterol 2000; 95: 3383-3387
    CrossrefPubMedGoogle Scholar
  • 27 Kerkhof M, van Dekken H, Steyerberg EW. et al. Grading of dysplasia in Barrett's oesophagus: substantial interobserver variation between general and gastrointestinal pathologists. Histopathology 2007; 50: 920-927
    CrossrefPubMedGoogle Scholar
  • 28 Sharma P. Low-grade dysplasia in Barrett's esophagus. Gastroenterology 2004; 127: 1233-1238
    CrossrefPubMedGoogle Scholar
  • 29 Monkemuller K. Radiofrequency ablation for Barrett's esophagus with confirmed low-grade dysplasia. JAMA 2014; 311: 1205-1206
    CrossrefPubMedGoogle Scholar
  • 30 Kim HP, Bulsiewicz WJ, Cotton CC. et al. Focal endoscopic mucosal resection before radiofrequency ablation is equally effective and safe compared with radiofrequency ablation alone for the eradication of Barrett's esophagus with advanced neoplasia. Gastrointest Endosc 2012; 76: 733-739
    CrossrefPubMedGoogle Scholar
  • 31 Jagadesham VP, Kelty CJ. Low grade dysplasia in Barrett's esophagus: Should we worry?. World J Gastrointest Pathophysiol 2014; 5: 91-99
    CrossrefPubMedGoogle Scholar
  • 32 Caillol F, Bories E, Pesenti C. et al. Radiofrequency ablation associated to mucosal resection in the oesophagus: experience in a single centre. Clin Res Hepatol Gastroenterol 2012; 36: 371-377
    CrossrefPubMedGoogle Scholar
  • 33 Qumseya BJ, Wani S, Desai M. et al. Adverse events after radiofrequency ablation in patients with Barrett's esophagus: a systematic review and meta-analysis. Clin Gastroenterol Hepatol 2016; 14: 1086-1095 e1086
    CrossrefPubMedGoogle Scholar