Copyright
©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Endosc. Mar 16, 2019; 11(3): 239-248
Published online Mar 16, 2019. doi: 10.4253/wjge.v11.i3.239
Treatment of high-grade dysplasia and intramucosal carcinoma using radiofrequency ablation or endoscopic mucosal resection + radiofrequency ablation: Meta-analysis and systematic review
Mileine Valente de Matos, Alberto Machado da Ponte-Neto, Diogo Turiani Hourneaux de Moura, Ethan Dwane Maahs, Dalton Marques Chaves, Elisa Ryoka Baba, Edson Ide, Rubens Sallum, Wanderley Marques Bernardo, Eduardo Guimarães Hourneaux de Moura
Mileine Valente de Matos, Alberto Machado da Ponte-Neto, Diogo Turiani Hourneaux de Moura, Dalton Marques Chaves, Elisa Ryoka Baba, Edson Ide, Eduardo Guimarães Hourneaux de Moura, Gastrointestinal Endoscopy Unit, Gastroenterology Department, University of Sao Paulo School of Medicine, São Paulo, SP 05403-000, Brazil
Ethan Dwane Maahs, Genetics, Genomics and Development (Molecular and Cell Biology) Department, University of California Berkeley, Berkeley, CA 97420, United States
Rubens Sallum, Gastrointestinal Surgery, Gastroenterology Department, University of Sao Paulo School of Medicine, São Paulo, SP 05403-000, Brazil
Wanderley Marques Bernardo, Thoracic Surgery Department, Instituto do Coração (InCor, Heart Institute), University of Sao Paulo School of Medicine, São Paulo, SP 05403-000, Brazil
Author contributions: Matos MV, Ponte-Neto AM, Moura DTH, Chaves DM, Baba ER, Ide E, Sallum R, Bernardo WM, Maahs ED, and Moura EGH contributed equally to the work; Matos MV and Moura EGH conceptualized and designed the review together; Matos MV, Ponte-Neto AM, and Bernardo WM carried out the analysis; Matos MV and Ponte-Neto AM drafted the initial manuscript; Maahs ED made reviewed the English; and all authors reviewed and approved the final manuscript as submitted.
Conflict-of-interest statement: The authors have no conflicts of interest.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Alberto Machado da Ponte Neto, MD, Academic Fellow, Gastrointestinal Endoscopy Unit, Gastroenterology Department, University of Sao Paulo School of Medicine, Avenida Dr. Enéas de Carvalho Aguiar, 155, 6 floor, São Paulo, SP 05403-000, Brazil. albertomachadoneto@gmail.com
Telephone: +55-11-973830966
Received: August 17, 2018
Peer-review started: August 17, 2018
First decision: August 31, 2018
Revised: January 28, 2019
Accepted: February 19, 2019
Article in press: February 20, 2019
Published online: March 16, 2019
BACKGROUND
The progression of Barrett’s esophagus (BE) to early esophageal carcinoma occurs sequentially; the metaplastic epithelium develops from a low-grade dysplasia to a high-grade dysplasia (HGD), resulting in early esophageal carcinoma and, eventually, invasive carcinoma. Endoscopic approaches including resection and ablation can be used in the treatment of this condition.
AIM
To compare the effectiveness of radiofrequency ablation (RFA) vs endoscopic mucosal resection (EMR) + RFA in the endoscopic treatment of HGD and intramucosal carcinoma.
METHODS
In accordance with PRISMA guidelines, this systematic review included studies comparing the two endoscopic techniques (EMR + RFA and RFA alone) in the treatment of HGD and intramucosal carcinoma in patients with BE. Our analysis included studies involving adult patients of any age with BE with HGD or intramucosal carcinoma. The studies compared RFA and EMR + RFA methods were included regardless of randomization status.
RESULTS
The seven studies included in this review represent a total of 1950 patients, with 742 in the EMR + RFA group and 1208 in the RFA alone group. The use of EMR + RFA was significantly more effective in the treatment of HGD [RD 0.35 (0.15, 0.56)] than was the use of RFA alone. The evaluated complications (stenosis, bleeding, and thoracic pain) were not significantly different between the two groups.
CONCLUSION
Endoscopic resection in combination with RFA is a safe and effective method in the treatment of HGD and intramucosal carcinoma, with higher rates of remission and no significant differences in complication rates when compared to the use of RFA alone.
Core tip: This study is important for providing a framework for an endoscopic intervention that can prevent the progression of Barrett's esophagus (BE) into early esophageal carcinoma. This meta-analysis aims to compare two endoscopic techniques, namely, radiofrequency ablation by the HALO system (RFA) alone and RFA in combination with an endoscopic resection (EMR+RFA), in the treatment of high-grade dysplasia and intramucosal carcinoma in patients with BE. It also aims to evaluate the efficiency of each treatment and the prevalence of adverse events.
