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
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.
Il testo completo di questo articolo è disponibile in PDF.Abbreviations : APC, BE, CE-D, CE-IM, HGD, RFA
Mappa
| DISCLOSURE: All authors disclosed no financial relationships relevant to this publication. |
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| See CME section: p. 821. |
Vol 79 - N° 5
P. 718 - maggio 2014 Ritorno al numero
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