Gastrointestinal endoscopy 2018 02 21() pii S0016-5107(18)30135-4
BACKGROUND AND AIMS
A small but significant proportion of patients with Barrett’s esophagus (BE) have persistent dysplasia or intestinal metaplasia (IM) after treatment with radiofrequency ablation (RFA). Cryotherapy is a cold-based ablative modality that is increasingly being used in this setting. We aimed to better understand the efficacy of second-line cryotherapy in BE patients with persistent dysplasia or IM after RFA by conducting a systematic review and meta-analysis.
We performed a systematic literature search of PUBMED, EMBASE, and Web of Sciences through September 1, 2017. Articles were included for meta-analysis based on the following inclusion criteria: ≥5 BE patients treated with RFA had persistent dysplasia or IM; they subsequently underwent ≥1 session of cryotherapy with follow-up endoscopy; the proportions of patients achieving complete eradication of dysplasia (CE-D) and/or IM (CE-IM) were reported. The main outcomes were pooled proportions of CE-D and CE-IM using a random effects model.
Eleven studies comprising 148 BE patients treated with cryotherapy for persistent dysplasia or IM after RFA were included. The pooled proportion of CE-D was 76.0% (95% CI, 57.7-88.0) with substantial heterogeneity (I=62%). The pooled proportion of CE-IM was 45.9% (95% CI, 32.0-60.5) with moderate heterogeneity (I=57%). Multiple pre-planned subgroup analyses did not sufficiently explain the heterogeneity. Adverse effects were reported in 6.7% of patients.
Cryotherapy successfully achieves CE-D in three-quarters and CE-IM in half of BE patients who do not respond to initial RFA. Considering its favorable safety profile, cryotherapy may be a viable second-line option for this therapeutically challenging cohort of BE patients, but higher-quality studies validating this remain warranted.