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
Barrett’s esophagus (BE) remains a challenging disease. BE associated with dysplasia is a difficult diagnosis for pathologists. Additionally, the adequate treatment and close follow-up of these patients is required. With the advent of new therapies, more studies have been done to unveil the best way to treat patients with this disease. One of the most promising techniques in the management of this condition is radiofrequency ablation (RFA). This approach can also be performed combined with resection methods, such as endoscopic mucosal resection (EMR). This systematic review and meta-analysis aimed to evaluate RFA alone or combined EMR (RFA + EMR) in the treatment of high-grade dysplasia (HGD) and intramucosal carcinoma in BE.
Radiofrequency ablation has been recognized with the method of choice for the treatment of BE with dysplasia. However, there is a question in the literature about the need to associate resection techniques such as EMR and endoscopic submucosal dissection in the treatment of these patients. Our study aims to assess whether the association of EMR adds benefit in the treatment of BE with HGD and intramucosal carcinoma.
The objective of our study is to evaluate the effectiveness of RFA and RFA+EMR in patients with BE with HGD and intramucosal carcinoma. This systematic review and meta-analysis can help colleagues in decision making regarding the treatment of this condition, as well as serve as a basis for future studies related to this subject.
This systematic review was conducted according to the PRISMA. The search was performed in electronic databases including Medline (via PubMed), LILACS and Cochrane. Studies comparing RFA and EMR + RFA in the treatment of HGD and intramural carcinoma were included. The Newcastle-Ottawa tool was used to evaluate the risk of bias and the applicability of primary diagnostic accuracy studies. The meta-analysis was performed using the RevMan5 software.
Seven studies were included with a total of 1950 patients, with 742 in the RFA + EMR group, and 1208 in the RFA isolate group. A higher eradication rate was observed in patients submitted to RFA + EMR compared to patients submitted to RFA isolated [RD 0.35 (0.15, 0.56)]. However, no statistical differences were observed regard to the bleeding rate, [SD 0.0 (-0.01, 0.02)], stenosis rate [RD 0.03 (0.00, 0.05)], and chest pain rate [SD -0.04 (-0.22, 0.13)].
This meta-analysis corroborates the idea of performing EMR+RFA in patients with BE with HGD or intramucosal carcinoma, without increasing the number of complications associated with the combination of RFA + EMR when compared to RFA alone. We believe that the association of these techniques allows a deeper elimination of BE with HGD or intramucosal carcinoma, without increasing the risk of the procedure for the patient, validating the association of these techniques in the treatment of this disease.
This systematic review and meta-analysis can help colleagues in decision making regarding the treatment of HGD or intramucosal carcinoma in BE, as well as serve as a basis for future studies related to this subject.