Clinical Endoscopy

  • 제57권2호
  • /
  • Pages.181-190
  • /
  • 2024
  • /
  • 2234-2400(pISSN)
  • /
  • 2234-2443(eISSN)
대한소화기내시경학회 (The Korean Society of Gastrointestinal Endoscopy)
권호 표지
DOI QR코드

DOI QR Code

Cryotherapy versus radiofrequency ablation in the treatment of dysplastic Barrett's esophagus with or without early esophageal neoplasia: a systematic review and meta-analysis

  • 투고 : 2023.02.27
  • 심사 : 2023.08.26
  • 발행 : 2024.03.30
PDF 다운로드
⟨ 이전 논문 다음 논문 ⟩

초록

Background/Aims: Radiofrequency ablation (RFA) is the first-line therapy for dysplastic Barrett's esophagus (BE). Therefore, cryotherapy has emerged as an alternative treatment option. This study aimed to compare the efficacies of these two techniques based on the rates of complete eradication of intestinal metaplasia (CE-IM) and dysplasia (CE-D). Adverse events and recurrence have also been reported. Methods: An electronic search was conducted using the Medline (PubMed), Embase, LILACS, and Google Scholar databases until December 2022. Studies were included comparing cryotherapy and RFA for treating dysplastic BE with or without early esophageal neoplasia. This study was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Results: Three retrospective cohort studies involving 627 patients were included. Of these, 399 patients underwent RFA, and 228 were treated with cryotherapy. There was no difference in CE-IM (risk difference [RD], -0.03; 95% confidence interval [CI], -0.25 to 0.19; p=0.78; I2=86%) as well as in CE-D (RD, -0.03; 95% CI, -0.15 to 0.09; p=0.64; I2=70%) between the groups. The absolute number of adverse events was low, and there was no difference in the recurrence rate. Conclusions: Cryotherapy and RFA were equally effective in treating dysplastic BE, with or without early esophageal neoplasia.

키워드

참고문헌

  1. Shaheen NJ, Sharma P, Overholt BF, et al. Radiofrequency ablation in Barrett's esophagus with dysplasia. N Engl J Med 2009;360:2277-2288. https://doi.org/10.1056/NEJMoa0808145
  2. Garg S, Xie J, Inamdar S, et al. Spatial distribution of dysplasia in Barrett's esophagus segments before and after endoscopic ablation therapy: a meta-analysis. Endoscopy 2021;53:6-14. https://doi.org/10.1055/a-1195-1000
  3. de Matos MV, da Ponte-Neto AM, de Moura DTH, et al. Treatment of high-grade dysplasia and intramucosal carcinoma using radiofrequency ablation or endoscopic mucosal resection + radiofrequency ablation: meta-analysis and systematic review. World J Gastrointest Endosc 2019;11:239-248. https://doi.org/10.4253/wjge.v11.i3.239
  4. Pouw RE, Klaver E, Phoa KN, et al. Radiofrequency ablation for lowg-rade dysplasia in Barrett's esophagus: long-term outcome of a randomized trial. Gastrointest Endosc 2020;92:569-574. https://doi.org/10.1016/j.gie.2020.03.3756
  5. Sawas T, Alsawas M, Bazerbachi F, et al. Persistent intestinal metaplasia after endoscopic eradication therapy of neoplastic Barrett's esophagus increases the risk of dysplasia recurrence: meta-analysis. Gastrointest Endosc 2019;89:913-925. https://doi.org/10.1016/j.gie.2018.11.035
  6. De Souza TF, Artifon EL, Mestieri LH, et al. Systematic review and meta-analysis of endoscopic ablative treatment of Barrett's esophagus. Rev Gastroenterol Peru 2014;34:217-224.
  7. Weusten B, Bisschops R, Coron E, et al. Endoscopic management of Barrett's esophagus: European Society of Gastrointestinal Endoscopy (ESGE) Position Statement. Endoscopy 2017;49:191-198. https://doi.org/10.1055/s-0042-122140
  8. Orman ES, Li N, Shaheen NJ. Efficacy and durability of radiofrequency ablation for Barrett's Esophagus: systematic review and meta-analysis. Clin Gastroenterol Hepatol 2013;11:1245-1255. https://doi.org/10.1016/j.cgh.2013.03.039
  9. Pandey G, Mulla M, Lewis WG, et al. Systematic review and meta-analysis of the effectiveness of radiofrequency ablation in low grade dysplastic Barrett's esophagus. Endoscopy 2018;50:953-960. https://doi.org/10.1055/a-0588-5151
  10. Wolfson P, Ho KMA, Wilson A, et al. Endoscopic eradication therapy for Barrett's esophagus-related neoplasia: a final 10-year report from the UK National HALO Radiofrequency Ablation Registry. Gastrointest Endosc 2022;96:223-233. https://doi.org/10.1016/j.gie.2022.02.016
  11. Barret M, Pioche M, Terris B, et al. Endoscopic radiofrequency ablation or surveillance in patients with Barrett's oesophagus with confirmed low-grade dysplasia: a multicentre randomised trial. Gut 2021;70:1014-1022. https://doi.org/10.1136/gutjnl-2020-322082
  12. Hamade N, Desai M, Thoguluva Chandrasekar V, et al. Efficacy of cryotherapy as first line therapy in patients with Barrett's neoplasia: a systematic review and pooled analysis. Dis Esophagus 2019;32:doz040.
  13. Tariq R, Enslin S, Hayat M, et al. Efficacy of cryotherapy as a primary endoscopic ablation modality for dysplastic Barrett's esophagus and early esophageal neoplasia: a systematic review and meta-analysis. Cancer Control 2020;27:1073274820976668.
  14. Visrodia K, Zakko L, Singh S, et al. Cryotherapy for persistent Barrett's esophagus after radiofrequency ablation: a systematic review and meta-analysis. Gastrointest Endosc 2018;87:1396-1404. https://doi.org/10.1016/j.gie.2018.02.021
  15. Trindade AJ, Inamdar S, Kothari S, et al. Feasibility of liquid nitrogen cryotherapy after failed radiofrequency ablation for Barrett's esophagus. Dig Endosc 2017;29:680-685. https://doi.org/10.1111/den.12869
  16. Solomon SS, Kothari S, Smallfield GB, et al. Liquid nitrogen spray cryotherapy is associated with less postprocedural pain than radiofrequency ablation in Barrett's esophagus: a multicenter prospective study. J Clin Gastroenterol 2019;53:e84-e90. https://doi.org/10.1097/MCG.0000000000000999
  17. Canto MI, Trindade AJ, Abrams J, et al. Multifocal cryoballoon ablation for eradication of Barrett's esophagus-related neoplasia: a prospective multicenter clinical trial. Am J Gastroenterol 2020;115:1879-1890. https://doi.org/10.14309/ajg.0000000000000822
  18. The Cochrane Collaboration. Cochrane Handbook for Systematic Reviews of Interventions version 6.0 [Internet]. The Cochrane Collaboration; 2019 [cited 2023 Jan 31]. Available from: https://training.cochrane.org/handbook
  19. GRADEpro. Guideline Development Tool software [Internet]. McMaster University; 2023 [cited 2023 Jan 31]. Available from: https://gdt.gradepro.org/app/
  20. Agarwal S, Alshelleh M, Scott J, et al. Comparative outcomes of radiofrequency ablation and cryoballoon ablation in dysplastic Barrett's esophagus: a propensity score-matched cohort study. Gastrointest Endosc 2022;95:422-431. https://doi.org/10.1016/j.gie.2021.09.037
  21. Fasullo M, Shah T, Patel M, et al. Outcomes of radiofrequency ablation compared to liquid nitrogen spray cryotherapy for the eradication of dysplasia in Barrett's esophagus. Dig Dis Sci 2022;67:2320-2326. https://doi.org/10.1007/s10620-021-06991-7
  22. Thota PN, Arora Z, Dumot JA, et al. Cryotherapy and radiofrequency ablation for eradication of Barrett's esophagus with dysplasia or intramucosal cancer. Dig Dis Sci 2018;63:1311-1319. https://doi.org/10.1007/s10620-018-5009-4
  23. van Munster SN, Overwater A, Haidry R, et al. Focal cryoballoon versus radiofrequency ablation of dysplastic Barrett's esophagus: impact on treatment response and postprocedural pain. Gastrointest Endosc 2018;88:795-803. https://doi.org/10.1016/j.gie.2018.06.015
  24. Canto MI, Shaheen NJ, Almario JA, et al. Multifocal nitrous oxide cryoballoon ablation with or without EMR for treatment of neoplastic Barrett's esophagus (with video). Gastrointest Endosc 2018;88:438-446. https://doi.org/10.1016/j.gie.2018.03.024
  25. Cotton CC, Wolf WA, Overholt BF, et al. Late recurrence of Barrett's esophagus after complete eradication of intestinal metaplasia is rare: final report from ablation in Intestinal Metaplasia Containing Dysplasia Trial. Gastroenterology 2017;153:681-688. https://doi.org/10.1053/j.gastro.2017.05.044
  26. Shaheen NJ, Falk GW, Iyer PG, et al. Diagnosis and management of Barrett's esophagus: an updated ACG guideline. Am J Gastroenterol 2022;117:559-587. https://doi.org/10.14309/ajg.0000000000001680
  27. Standards of Practice Committee, Wani S, Qumseya B, et al. Endoscopic eradication therapy for patients with Barrett's esophagus-associated dysplasia and intramucosal cancer. Gastrointest Endosc 2018;87:907-931. https://doi.org/10.1016/j.gie.2017.10.011
  28. Wani S, Muthusamy VR, Shaheen NJ, et al. Development of quality indicators for endoscopic eradication therapies in Barrett's esophagus: the TREAT-BE (Treatment with Resection and Endoscopic Ablation Techniques for Barrett's Esophagus) Consortium. Gastrointest Endosc 2017;86:1-17.