Systematic review and meta-analysis of the effectiveness of radiofrequency ablation in low grade dysplastic Barrett's esophagus

Background -Barrett's esophagus (BE) is a premalignant condition characterized by replacement of the esophageal lining with metastatic columnar epithelium, and its management when complicated by low grade dysplasia (LGD) is controversial. This systematic review and meta-analysis aimed to determine the efficacy of radiofrequency ablation (RFA) in patients with LGD. Methods -MEDLINE, EMBASE, and Web of Science were searched for studies including patients with BE-associated LGD receiving RFA (January 1990 to May 2017). The outcome measures were complete eradication of intestinal metaplasia (CE-IM) and dysplasia (CE-D), rates of progression to high grade dysplasia (HGD) or cancer, and recurrence. Results -Eight studies including 619 patients with LGD (RFA=404, surveillance=215) were analyzed. After a median follow-up of 26 months (range 12-44 months), the overall pooled rates of CE-IM and CE-D after RFA were 88.17% (95% confidence interval [CI] 88.13%-88.20%; P <0.001) and 96.69% (95%CI 96.67%-96.71%; P <0.001), respectively. When compared with surveillance, RFA resulted in significantly lower rates of progression to HGD or cancer (odds ratio [OR] 0.07, 95%CI 0.02-0.22). The pooled recurrence rates of IM and dysplasia were 5.6% (95%CI 5.57-5.63; P <0.001) and 9.66% (95%CI 9.61-9.71; P <0.001), respectively. Conclusions -RFA safely eradicates IM and dysplasia and reduces the rates of progression from LGD to HGD or cancer in the short term.