Systematic review comparing radiofrequency ablation and complete endoscopic resection in treating dysplastic Barrett's esophagus: a critical assessment of histologic outcomes and adverse events

• Published in: Gastrointestinal endoscopy Vol. 79; no. 5; pp. 718 - 731.e3
• Main Authors: Chadwick, Georgina, MRCP, Groene, Oliver, PhD, Markar, Sheraz R., MRCS, Hoare, Jonathan, PhD, Cromwell, David, PhD, Hanna, George B., PhD
• Format: Journal Article
• Language: English
• Published: United States Mosby, Inc 01.05.2014
• Subjects: Barrett Esophagus - pathology; Barrett Esophagus - surgery; Catheter Ablation - adverse effects; Esophagoscopy - adverse effects; Esophagus - pathology; Gastroenterology and Hepatology; Humans; Metaplasia - surgery; Mucous Membrane - pathology; Mucous Membrane - surgery; Time Factors; Treatment Outcome; BE; APC; HGD; CE-D; complete eradication of dysplasia; Barrett's esophagus; complete eradication of intestinal metaplasia; argon plasma coagulation; high-grade dysplasia; RFA; radiofrequency ablation; CE-IM
• ISSN: 0016-5107; 1097-6779
• DOI: 10.1016/j.gie.2013.11.030

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.