Meta-Analysis
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
Processing time: 216 Days and 20.4 Hours
ARTICLE HIGHLIGHTS
Research background

Barrett’s esophagus (BE) remains a challenging disease. BE associated with dysplasia is a difficult diagnosis for pathologists. Additionally, the adequate treatment and close follow-up of these patients is required. With the advent of new therapies, more studies have been done to unveil the best way to treat patients with this disease. One of the most promising techniques in the management of this condition is radiofrequency ablation (RFA). This approach can also be performed combined with resection methods, such as endoscopic mucosal resection (EMR). This systematic review and meta-analysis aimed to evaluate RFA alone or combined EMR (RFA + EMR) in the treatment of high-grade dysplasia (HGD) and intramucosal carcinoma in BE.

Research motivation

Radiofrequency ablation has been recognized with the method of choice for the treatment of BE with dysplasia. However, there is a question in the literature about the need to associate resection techniques such as EMR and endoscopic submucosal dissection in the treatment of these patients. Our study aims to assess whether the association of EMR adds benefit in the treatment of BE with HGD and intramucosal carcinoma.

Research objectives

The objective of our study is to evaluate the effectiveness of RFA and RFA+EMR in patients with BE with HGD and intramucosal carcinoma. This systematic review and meta-analysis can help colleagues in decision making regarding the treatment of this condition, as well as serve as a basis for future studies related to this subject.

Research methods

This systematic review was conducted according to the PRISMA. The search was performed in electronic databases including Medline (via PubMed), LILACS and Cochrane. Studies comparing RFA and EMR + RFA in the treatment of HGD and intramural carcinoma were included. The Newcastle-Ottawa tool was used to evaluate the risk of bias and the applicability of primary diagnostic accuracy studies. The meta-analysis was performed using the RevMan5 software.

Research results

Seven studies were included with a total of 1950 patients, with 742 in the RFA + EMR group, and 1208 in the RFA isolate group. A higher eradication rate was observed in patients submitted to RFA + EMR compared to patients submitted to RFA isolated [RD 0.35 (0.15, 0.56)]. However, no statistical differences were observed regard to the bleeding rate, [SD 0.0 (-0.01, 0.02)], stenosis rate [RD 0.03 (0.00, 0.05)], and chest pain rate [SD -0.04 (-0.22, 0.13)].

Research conclusions

This meta-analysis corroborates the idea of performing EMR+RFA in patients with BE with HGD or intramucosal carcinoma, without increasing the number of complications associated with the combination of RFA + EMR when compared to RFA alone. We believe that the association of these techniques allows a deeper elimination of BE with HGD or intramucosal carcinoma, without increasing the risk of the procedure for the patient, validating the association of these techniques in the treatment of this disease.

Research perspectives

This systematic review and meta-analysis can help colleagues in decision making regarding the treatment of HGD or intramucosal carcinoma in BE, as well as serve as a basis for future studies related to this subject.