Original article
Systematic reviews and meta-analyses
Efficacy and Durability of Radiofrequency Ablation for Barrett's Esophagus: Systematic Review and Meta-analysis

https://doi.org/10.1016/j.cgh.2013.03.039Get rights and content

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.

Section snippets

Search Strategy and Eligibility Criteria

We followed the Meta-analysis Of Observational Studies in Epidemiology guidelines for the conduct and reporting of systematic reviews of observational studies.14 Two authors (E.S.O. and N.L.) independently searched the PubMed and EMBASE databases for relevant articles on August 24, 2012. PubMed was queried with the search terms “((Barrett) OR Barrett's) AND (radiofrequency OR radio-frequency OR ablation)” and EMBASE was queried with “Barrett AND (‘radiofrequency’/exp OR radiofrequency OR

Search Results

Of the 1191 unique records identified, 1069 were excluded based on title and abstract review alone (Figure 1). An additional 102 records were excluded after full-text review because of non-English language (n = 2), no RFA (n = 3), no focal RFA (n = 4), the use of other ablative therapies (n = 16), no report of either efficacy or durability (n = 15), mean follow-up period less than 12 months (n = 4), fewer than 20 subjects (n = 3), duplicate reports of study samples (n = 23), abstracts published

Discussion

RFA has emerged as a preferred method for the endoscopic ablation of BE.1 It safely and effectively eradicates dysplasia and IM, and for those with HGD it reduces progression to cancer.8 In this systematic review and meta-analysis, we estimated the proportion of patients treated with RFA who achieved eradication of dysplasia and IM and the proportion of patients with recurrence of IM after successful treatment. We found that RFA resulted in CE-D in 91% of patients and CE-IM in 78% of patients,

References (41)

  • F. Caillol et al.

    Radiofrequency ablation associated to mucosal resection in the oesophagus: experience in a single centre

    Clin Res Hepatol Gastroenterol

    (2012)
  • K. Krishnan et al.

    Increased risk for persistent intestinal metaplasia in patients with Barrett's esophagus and uncontrolled reflux exposure before radiofrequency ablation

    Gastroenterology

    (2012)
  • P.S. Dulai et al.

    Size really doesn't matter - a single center experience with radiofrequency ablation of ultra long-segment Barrett's esophagus

    Gastrointest Endosc

    (2012)
  • M. Gupta et al.

    Safety and outcomes of radiofrequency ablation for Barrett's esophagus in older subjects: results from a betrnet consortium

    Gastrointest Endosc

    (2012)
  • J. Martinek et al.

    Endoscopic radiofrequency ablation combined with endoscopic resection for early neoplasia in Barrett's esophagus longer than 7 CM

    Gastrointest Endosc

    (2012)
  • N.J. Shaheen et al.

    Eradication rates of Barrett's esophagus using radiofrequency ablation (RFA): results from the U.S. RFA registry

    Gastrointest Endosc

    (2012)
  • R.A. Ganz et al.

    Complete ablation of esophageal epithelium with a balloon-based bipolar electrode: a phased evaluation in the porcine and in the human esophagus

    Gastrointest Endosc

    (2004)
  • P. Sharma et al.

    Dysplasia and cancer in a large multicenter cohort of patients with Barrett's esophagus

    Clin Gastroenterol Hepatol

    (2006)
  • F.P. Peters et al.

    Histologic evaluation of resection specimens obtained at 293 endoscopic resections in Barrett's esophagus

    Gastrointest Endosc

    (2008)
  • J.J. Lewis et al.

    Factors associated with esophageal stricture formation after endoscopic mucosal resection for neoplastic Barrett's esophagus

    Gastrointest Endosc

    (2011)

    • Cited by (247)

    View all citing articles on Scopus

    Conflicts of interest This author discloses the following: Dr Shaheen has received research grants from BARRX Medical, Oncoscope, CSA Medical, Takeda, and AstraZeneca; and is a consultant for CSA Medical, AstraZeneca, Takeda, Oncoscope, and NeoGenomics. The remaining authors disclose no conflicts.

    Funding Supported in part by the National Institutes of Health (T32 DK07634 and UL1TR000083).

    View full text
    Copyright © 2013 AGA Institute. Published by Elsevier Ltd. All rights reserved.