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

Kavel Visrodia, Liam Zakko, Siddharth Singh, Cadman Leggett, Prasad G Iyer, Kenneth Ke Ning Wang

Research output: Contribution to journalReview article

6 Citations (Scopus)

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 patients with BE who have 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 Science through September 1, 2017. Articles were included for meta-analysis based on the following inclusion criteria: ≥5 patients with BE 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 by using a random effects model. Results: Eleven studies making up 148 patients with BE treated with cryotherapy for persistent dysplasia or IM after RFA were included. The pooled proportion of CE-D was 76.0% (95% confidence interval [CI] 57.7-88.0), with substantial heterogeneity (I2 = 62%). The pooled proportion of CE-IM was 45.9% (95% CI, 32.0-60.5) with moderate heterogeneity (I2 = 57%). Multiple preplanned subgroup analyses did not sufficiently explain the heterogeneity. Adverse effects were reported in 6.7% of patients. Conclusion: Cryotherapy successfully achieved CE-D in three fourths and CE-IM in half of patients with BE who did not respond to initial RFA. Considering its favorable safety profile, cryotherapy may be a viable second-line option for this therapeutically challenging cohort of patients with BE, but higher-quality studies validating this remain warranted.

Original languageEnglish (US)
Pages (from-to)1396-1404.e1
JournalGastrointestinal Endoscopy
Volume87
Issue number6
DOIs
StatePublished - Jun 1 2018

Fingerprint

Cryotherapy
Barrett Esophagus
Meta-Analysis
Metaplasia
Confidence Intervals
PubMed
Endoscopy
Safety

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Gastroenterology

Cite this

Cryotherapy for persistent Barrett's esophagus after radiofrequency ablation : a systematic review and meta-analysis. / Visrodia, Kavel; Zakko, Liam; Singh, Siddharth; Leggett, Cadman; Iyer, Prasad G; Wang, Kenneth Ke Ning.

In: Gastrointestinal Endoscopy, Vol. 87, No. 6, 01.06.2018, p. 1396-1404.e1.

Research output: Contribution to journalReview article

@article{9389cc3ac1cc4c24aa457385683dea9d,
title = "Cryotherapy for persistent Barrett's esophagus after radiofrequency ablation: a systematic review and meta-analysis",
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 patients with BE who have 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 Science through September 1, 2017. Articles were included for meta-analysis based on the following inclusion criteria: ≥5 patients with BE 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 by using a random effects model. Results: Eleven studies making up 148 patients with BE treated with cryotherapy for persistent dysplasia or IM after RFA were included. The pooled proportion of CE-D was 76.0{\%} (95{\%} confidence interval [CI] 57.7-88.0), with substantial heterogeneity (I2 = 62{\%}). The pooled proportion of CE-IM was 45.9{\%} (95{\%} CI, 32.0-60.5) with moderate heterogeneity (I2 = 57{\%}). Multiple preplanned subgroup analyses did not sufficiently explain the heterogeneity. Adverse effects were reported in 6.7{\%} of patients. Conclusion: Cryotherapy successfully achieved CE-D in three fourths and CE-IM in half of patients with BE who did not respond to initial RFA. Considering its favorable safety profile, cryotherapy may be a viable second-line option for this therapeutically challenging cohort of patients with BE, but higher-quality studies validating this remain warranted.",
author = "Kavel Visrodia and Liam Zakko and Siddharth Singh and Cadman Leggett and Iyer, {Prasad G} and Wang, {Kenneth Ke Ning}",
year = "2018",
month = "6",
day = "1",
doi = "10.1016/j.gie.2018.02.021",
language = "English (US)",
volume = "87",
pages = "1396--1404.e1",
journal = "Gastrointestinal Endoscopy",
issn = "0016-5107",
publisher = "Mosby Inc.",
number = "6",

}

TY - JOUR

T1 - Cryotherapy for persistent Barrett's esophagus after radiofrequency ablation

T2 - a systematic review and meta-analysis

AU - Visrodia, Kavel

AU - Zakko, Liam

AU - Singh, Siddharth

AU - Leggett, Cadman

AU - Iyer, Prasad G

AU - Wang, Kenneth Ke Ning

PY - 2018/6/1

Y1 - 2018/6/1

N2 - 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 patients with BE who have 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 Science through September 1, 2017. Articles were included for meta-analysis based on the following inclusion criteria: ≥5 patients with BE 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 by using a random effects model. Results: Eleven studies making up 148 patients with BE treated with cryotherapy for persistent dysplasia or IM after RFA were included. The pooled proportion of CE-D was 76.0% (95% confidence interval [CI] 57.7-88.0), with substantial heterogeneity (I2 = 62%). The pooled proportion of CE-IM was 45.9% (95% CI, 32.0-60.5) with moderate heterogeneity (I2 = 57%). Multiple preplanned subgroup analyses did not sufficiently explain the heterogeneity. Adverse effects were reported in 6.7% of patients. Conclusion: Cryotherapy successfully achieved CE-D in three fourths and CE-IM in half of patients with BE who did not respond to initial RFA. Considering its favorable safety profile, cryotherapy may be a viable second-line option for this therapeutically challenging cohort of patients with BE, but higher-quality studies validating this remain warranted.

AB - 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 patients with BE who have 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 Science through September 1, 2017. Articles were included for meta-analysis based on the following inclusion criteria: ≥5 patients with BE 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 by using a random effects model. Results: Eleven studies making up 148 patients with BE treated with cryotherapy for persistent dysplasia or IM after RFA were included. The pooled proportion of CE-D was 76.0% (95% confidence interval [CI] 57.7-88.0), with substantial heterogeneity (I2 = 62%). The pooled proportion of CE-IM was 45.9% (95% CI, 32.0-60.5) with moderate heterogeneity (I2 = 57%). Multiple preplanned subgroup analyses did not sufficiently explain the heterogeneity. Adverse effects were reported in 6.7% of patients. Conclusion: Cryotherapy successfully achieved CE-D in three fourths and CE-IM in half of patients with BE who did not respond to initial RFA. Considering its favorable safety profile, cryotherapy may be a viable second-line option for this therapeutically challenging cohort of patients with BE, but higher-quality studies validating this remain warranted.

UR - http://www.scopus.com/inward/record.url?scp=85047113509&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85047113509&partnerID=8YFLogxK

U2 - 10.1016/j.gie.2018.02.021

DO - 10.1016/j.gie.2018.02.021

M3 - Review article

C2 - 29476849

AN - SCOPUS:85047113509

VL - 87

SP - 1396-1404.e1

JO - Gastrointestinal Endoscopy

JF - Gastrointestinal Endoscopy

SN - 0016-5107

IS - 6

ER -