Efficacy and safety outcomes of multimodal endoscopic eradication therapy in Barrett's esophagus-related neoplasia: a systematic review and pooled-analysis Journal Article

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Authors: Desai, M; Saligram, S.; Gupta, N; Vennalaganti, P; Bansal, A; Choudhary, A; Vennelaganti, S; He, J; Titi, M; Maselli, R.; Qumseya, B.; Olyaee, M.; Waxman, I.; Repici, A; Hassan, C; Sharma, P
Article Title: Efficacy and safety outcomes of multimodal endoscopic eradication therapy in Barrett's esophagus-related neoplasia: a systematic review and pooled-analysis
Abstract: BACKGROUND AIMS: Focal endoscopic mucosal resection followed by radiofrequency ablation (f-EMR+RFA) and step-wise or complete EMR(sEMR) are established strategies for eradication of Barrett's esophagus (BE)-related high-grade dysplasia(HGD) and/or intra-mucosal cancer(EAC/IMC). Objective of this study was to derive pooled rates of efficacy and safety of individual method in a large cohort of BE patients and to perform indirect comparison between 2 methods. METHODS: PubMed, Embase, Web of Science, Cochrane and major conference proceedings were searched. A systematic review and pooled analysis was carried out to determine following outcomes in BE patients undergoing either f-EMR+RFA or sEMR: (1) complete eradication rates of neoplasia(CE-N) and intestinal metaplasia(CE-IM) (2) recurrence rates (RR) of cancer (EAC), dysplasia and IM (3) incidence rates of adverse events. Mixed logistic regression was performed as exploratory analysis to examine differences in outcomes between the 2 methods. RESULTS: Nine studies (774 patients) of f-EMR+RFA and eleven studies (751 patients) of sEMR were included. Patients undergoing f-EMR+RFA had high BE eradication rates: CE-N 93.4% and CE-IM 73.1% whereas strictures occurred in 10.2%, bleeding 1.1%, and perforations in 0.2% patients. Recurrence of EAC, dysplasia, and IM was 1.4%, 2.6%, and 16.1% in this group. Patients undergoing sEMR also showed high BE eradication rates (CE-N 94.9% and CE-IM 79.6%) but a higher rate of adverse events: strictures in 33.5%, bleeding in 7.5%, and perforation in 1.3%. Recurrence of EAC, dysplasia, and IM was 0.7%, 3.3%, and 12.1% in the sEMR group. Mixed logistic regression showed that patients undergoing sEMR might be more likely to develop esophageal strictures (odds ratio [OR], 4.73; 95% CI, 1.61-13.85; p 0.005), perforation (OR, 7.00; 95% CI, 1.56-31.33; p 0.01), and bleeding (OR, 6.88; 95% CI, 2.19-21.62; p 0.001) compared with f-EMR+RFA. CONCLUSION: In BE patients with HGD/EAC, f-EMR followed by RFA appears to be equally effective and safer compared with step-wise EMR.
Journal Title: Gastrointestinal endoscopy
ISSN: 1097-6779; 0016-5107
Publisher: American Society for Gastrointestinal Endoscopy. Published by Elsevier Inc  
Journal Place: United States
Date Published: 2016
Language: ENG
DOI/URL:

S0016-5107(16)30591-0
Notes: LR: 20160927; CI: Copyright (c) 2016; JID: 0010505; OTO: NOTNLM; 2016/07/25 [received]; 2016/09/12 [accepted]; aheadofprint