Published online Mar 16, 2019. doi: 10.4253/wjge.v11.i3.239
Peer-review started: August 17, 2018
First decision: August 31, 2018
Revised: January 28, 2019
Accepted: February 19, 2019
Article in press: February 20, 2019
Published online: March 16, 2019
The progression of Barrett’s esophagus (BE) to early esophageal carcinoma occurs sequentially; the metaplastic epithelium develops from a low-grade dysplasia to a high-grade dysplasia (HGD), resulting in early esophageal carcinoma and, eventually, invasive carcinoma. Endoscopic approaches including resection and ablation can be used in the treatment of this condition.
To compare the effectiveness of radiofrequency ablation (RFA) vs endoscopic mucosal resection (EMR) + RFA in the endoscopic treatment of HGD and intramucosal carcinoma.
In accordance with PRISMA guidelines, this systematic review included studies comparing the two endoscopic techniques (EMR + RFA and RFA alone) in the treatment of HGD and intramucosal carcinoma in patients with BE. Our analysis included studies involving adult patients of any age with BE with HGD or intramucosal carcinoma. The studies compared RFA and EMR + RFA methods were included regardless of randomization status.
The seven studies included in this review represent a total of 1950 patients, with 742 in the EMR + RFA group and 1208 in the RFA alone group. The use of EMR + RFA was significantly more effective in the treatment of HGD [RD 0.35 (0.15, 0.56)] than was the use of RFA alone. The evaluated complications (stenosis, bleeding, and thoracic pain) were not significantly different between the two groups.
Endoscopic resection in combination with RFA is a safe and effective method in the treatment of HGD and intramucosal carcinoma, with higher rates of remission and no significant differences in complication rates when compared to the use of RFA alone.
Core tip: This study is important for providing a framework for an endoscopic intervention that can prevent the progression of Barrett's esophagus (BE) into early esophageal carcinoma. This meta-analysis aims to compare two endoscopic techniques, namely, radiofrequency ablation by the HALO system (RFA) alone and RFA in combination with an endoscopic resection (EMR+RFA), in the treatment of high-grade dysplasia and intramucosal carcinoma in patients with BE. It also aims to evaluate the efficiency of each treatment and the prevalence of adverse events.