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Cryotherapy for persistent Barrett’s esophagus after radiofrequency ablation: a systematic review and meta-analysis.

Cryotherapy for persistent Barrett’s esophagus after radiofrequency ablation: a systematic review and meta-analysis.
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Visrodia K, Zakko L, Singh S, Leggett CL, Iyer PG, Wang KK,


Visrodia K, Zakko L, Singh S, Leggett CL, Iyer PG, Wang KK, (click to view)

Visrodia K, Zakko L, Singh S, Leggett CL, Iyer PG, Wang KK,

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Gastrointestinal endoscopy 2018 02 21() pii S0016-5107(18)30135-4
Abstract
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.

METHODS
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.

RESULTS
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.

CONCLUSIONS
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.

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