Systematic review comparing radiofrequency ablation and complete endoscopic resection in treating dysplastic Barrett's esophagus: a critical assessment of histologic outcomes and adverse events - 09/04/14

Doi : 10.1016/j.gie.2013.11.030

Georgina Chadwick, MRCP ^1,^⁎, Oliver Groene, PhD ^1,², Sheraz R. Markar, MRCS ³, Jonathan Hoare, PhD ⁴, David Cromwell, PhD ^1,², George B. Hanna, PhD ³
¹ Clinical Effectiveness Unit, The Royal College of Surgeons of England, London, United Kingdom
² Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, London, United Kingdom
³ Department of Surgery and Cancer, St. Mary's Hospital, London, United Kingdom
⁴ Department of Gastroenterology, St. Mary's Hospital, London, United Kingdom

^∗Reprint requests: Georgina Chadwick, Clinical Research Fellow, Clinical Effectiveness Unit, The Royal College of Surgeons of England, 35-43 Lincoln's Inn Field, London, WC2A 3PE.

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.