Journal
DIGESTIVE DISEASES
Volume 39, Issue 6, Pages 561-568Publisher
KARGER
DOI: 10.1159/000514786
Keywords
Barrett's esophagus; Dysplasia; Endoscopic surveillance; Esophageal adenocarcinoma
Categories
Ask authors/readers for more resources
This systematic review and meta-analysis compared the risk of progression to high-grade dysplasia (HGD) or esophageal adenocarcinoma (EAC) in patients with Barrett's esophagus with low-grade dysplasia (BE-LGD) treated with radiofrequency ablation (RFA) versus endoscopic surveillance. The results showed a significant reduction in the risk of progression to HGD or EAC in patients treated with RFA compared to those undergoing endoscopic surveillance, supporting RFA as the preferred management approach for BE-LGD.
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.
Authors
I am an author on this paper
Click your name to claim this paper and add it to your profile.
Reviews
Recommended
No Data Available