Efficacy of radiofrequency ablation in eradication of low grade dysplasia Barrett’s esophagus: a meta-analysis
Background: Barrett esophagus containing low-grade dysplasia (LGD) is associatd with an increased risk of developing esophageal adenocarcinoma, a cancer with a rapidly increasing incidence noted for the past decades. Currently, the standard of care is intensive medical therapy with proton pump inhibition and endoscopic surveillance. Other possible therapeutic option are aside from endoscopic surveillance and acid suppression therapy includes endoscopic eradication with Radiofrequency ablation (RFA). This meta-analysis aims to determine whether RFA, confers additional benefit in eradication of LGD when used in conjunction with existing standard therapy and lowers rate of disease progression.
Methods: Included are three Randomized Single-Center and Multi center Controlled Trials that examined a total of 261 adult patients with LGD Barrett’s esophagus confirmed by biopsy divided into two arm one receiving RFA and standard therapy and the other receiving standard therapy alone. Primary outcome measured include the eradication of LGD and secondary outcomes were prevention of disease progression and associated adverse events. Results: All three trials individually registered a higher incidence of eradication of low grade dysplasia (LGD) in the experimental arm compared to the control arm with no significant heterogeneity between the three trials (I2: 0%; Chi2: 1.25; P value: 0.54). When it comes to prevention of progression from LGD to high grade dysplasia (HGD) and or carcinoma during a 3 year observation, two of studies also favors the experimental arm. There was also no noted significant heterogenecity (I2: 73%; Chi2: 3.71; P value: 0.05) between the two groups. Conclusion: The authors conclude that RFA in addition to PPI has a higher rate of eradication of LGD compared to PPI alone and is proven to have lower incidence of progression from LGD to HGD and or carcinoma. However, it was associated with adverse reactions including hemorrhage, stricture formation and severe chest pain which all resolved in the course of study.