Disease Progression in Barrett’s Low-Grade Dysplasia With Radiofrequency Ablation Compared With Surveillance: Systematic Review and Meta-Analysis

Bashar J. Qumseya, Sachin Wani, Sherif Gendy, Ben Harnke, Jacques J. Bergman, Herbert Wolfsen

Research output: Contribution to journalArticle

20 Citations (Scopus)

Abstract

Objectives:Barrett’s esophagus (BE) is the only identifiable premalignant condition for esophageal adenocarcinoma (EAC). Management of BE with low-grade dysplasia continues to be controversial. We aimed to conduct a systematic review and meta-analysis comparing the risk of progression to high-grade dysplasia or EAC among patients with BE with low-grade dysplasia treated with radiofrequency ablation (RFA) compared with surveillance endoscopy.METHODS:Our search included Medline, Embase, and Cochrane Central, was limited to English language articles, and was last searched on 31 December 2015. Studies were reviewed by title and abstract, and then full text by two independent reviewers. Two independent reviewers extracted data. Differences were resolved by consensus. The primary outcome of interest was the relative risk of disease progression among patients with BE with low-grade dysplasia treated with RFAcompared with surveillance.RESULTS:Our search resulted in 2,029 citations, 19 studies were included in the final analysis, totaling 2,746 patients. Relative risk of disease progression in RFA compared with surveillance was 0.14% (95% confidence interval: 0.04–0.45), P=0.001. This measure was stable when only all studies were included. Absolute risk reduction was 10.9% and the number needed to treat was 9.2. Results were stable over several quality measures, overtime, and when excluding randomized trials. The cumulative rate of progression to high-grade dysplasia/EAC was lower in RFA compared with surveillance (1.7% vs. 12.6%, P<0.001).Conclusions:Similarly, the incidence rate of progression among patients with surveillance was significantly higher from those treated with RFA (0.022 vs. 0.005, P<0.001). RFA results in a significant reduction risk of disease progression to high-grade dysplasia/EAC among patients with BE with low-grade dysplasia.Am J Gastroenterol advance online publication, 4 April 2017; doi:10.1038/ajg.2017.70.

Original languageEnglish (US)
JournalAmerican Journal of Gastroenterology
DOIs
StateAccepted/In press - Apr 4 2017

Fingerprint

Barrett Esophagus
Disease Progression
Meta-Analysis
Adenocarcinoma
Numbers Needed To Treat
Risk Reduction Behavior
Endoscopy
Publications
Consensus
Language
Confidence Intervals
Incidence

ASJC Scopus subject areas

  • Gastroenterology

Cite this

Disease Progression in Barrett’s Low-Grade Dysplasia With Radiofrequency Ablation Compared With Surveillance : Systematic Review and Meta-Analysis. / Qumseya, Bashar J.; Wani, Sachin; Gendy, Sherif; Harnke, Ben; Bergman, Jacques J.; Wolfsen, Herbert.

In: American Journal of Gastroenterology, 04.04.2017.

Research output: Contribution to journalArticle

@article{dd9be9cce2d140e28e2f29bb2549aa8b,
title = "Disease Progression in Barrett’s Low-Grade Dysplasia With Radiofrequency Ablation Compared With Surveillance: Systematic Review and Meta-Analysis",
abstract = "Objectives:Barrett’s esophagus (BE) is the only identifiable premalignant condition for esophageal adenocarcinoma (EAC). Management of BE with low-grade dysplasia continues to be controversial. We aimed to conduct a systematic review and meta-analysis comparing the risk of progression to high-grade dysplasia or EAC among patients with BE with low-grade dysplasia treated with radiofrequency ablation (RFA) compared with surveillance endoscopy.METHODS:Our search included Medline, Embase, and Cochrane Central, was limited to English language articles, and was last searched on 31 December 2015. Studies were reviewed by title and abstract, and then full text by two independent reviewers. Two independent reviewers extracted data. Differences were resolved by consensus. The primary outcome of interest was the relative risk of disease progression among patients with BE with low-grade dysplasia treated with RFAcompared with surveillance.RESULTS:Our search resulted in 2,029 citations, 19 studies were included in the final analysis, totaling 2,746 patients. Relative risk of disease progression in RFA compared with surveillance was 0.14{\%} (95{\%} confidence interval: 0.04–0.45), P=0.001. This measure was stable when only all studies were included. Absolute risk reduction was 10.9{\%} and the number needed to treat was 9.2. Results were stable over several quality measures, overtime, and when excluding randomized trials. The cumulative rate of progression to high-grade dysplasia/EAC was lower in RFA compared with surveillance (1.7{\%} vs. 12.6{\%}, P<0.001).Conclusions:Similarly, the incidence rate of progression among patients with surveillance was significantly higher from those treated with RFA (0.022 vs. 0.005, P<0.001). RFA results in a significant reduction risk of disease progression to high-grade dysplasia/EAC among patients with BE with low-grade dysplasia.Am J Gastroenterol advance online publication, 4 April 2017; doi:10.1038/ajg.2017.70.",
author = "Qumseya, {Bashar J.} and Sachin Wani and Sherif Gendy and Ben Harnke and Bergman, {Jacques J.} and Herbert Wolfsen",
year = "2017",
month = "4",
day = "4",
doi = "10.1038/ajg.2017.70",
language = "English (US)",
journal = "American Journal of Gastroenterology",
issn = "0002-9270",
publisher = "Nature Publishing Group",

}

TY - JOUR

T1 - Disease Progression in Barrett’s Low-Grade Dysplasia With Radiofrequency Ablation Compared With Surveillance

T2 - Systematic Review and Meta-Analysis

AU - Qumseya, Bashar J.

AU - Wani, Sachin

AU - Gendy, Sherif

AU - Harnke, Ben

AU - Bergman, Jacques J.

AU - Wolfsen, Herbert

PY - 2017/4/4

Y1 - 2017/4/4

N2 - Objectives:Barrett’s esophagus (BE) is the only identifiable premalignant condition for esophageal adenocarcinoma (EAC). Management of BE with low-grade dysplasia continues to be controversial. We aimed to conduct a systematic review and meta-analysis comparing the risk of progression to high-grade dysplasia or EAC among patients with BE with low-grade dysplasia treated with radiofrequency ablation (RFA) compared with surveillance endoscopy.METHODS:Our search included Medline, Embase, and Cochrane Central, was limited to English language articles, and was last searched on 31 December 2015. Studies were reviewed by title and abstract, and then full text by two independent reviewers. Two independent reviewers extracted data. Differences were resolved by consensus. The primary outcome of interest was the relative risk of disease progression among patients with BE with low-grade dysplasia treated with RFAcompared with surveillance.RESULTS:Our search resulted in 2,029 citations, 19 studies were included in the final analysis, totaling 2,746 patients. Relative risk of disease progression in RFA compared with surveillance was 0.14% (95% confidence interval: 0.04–0.45), P=0.001. This measure was stable when only all studies were included. Absolute risk reduction was 10.9% and the number needed to treat was 9.2. Results were stable over several quality measures, overtime, and when excluding randomized trials. The cumulative rate of progression to high-grade dysplasia/EAC was lower in RFA compared with surveillance (1.7% vs. 12.6%, P<0.001).Conclusions:Similarly, the incidence rate of progression among patients with surveillance was significantly higher from those treated with RFA (0.022 vs. 0.005, P<0.001). RFA results in a significant reduction risk of disease progression to high-grade dysplasia/EAC among patients with BE with low-grade dysplasia.Am J Gastroenterol advance online publication, 4 April 2017; doi:10.1038/ajg.2017.70.

AB - Objectives:Barrett’s esophagus (BE) is the only identifiable premalignant condition for esophageal adenocarcinoma (EAC). Management of BE with low-grade dysplasia continues to be controversial. We aimed to conduct a systematic review and meta-analysis comparing the risk of progression to high-grade dysplasia or EAC among patients with BE with low-grade dysplasia treated with radiofrequency ablation (RFA) compared with surveillance endoscopy.METHODS:Our search included Medline, Embase, and Cochrane Central, was limited to English language articles, and was last searched on 31 December 2015. Studies were reviewed by title and abstract, and then full text by two independent reviewers. Two independent reviewers extracted data. Differences were resolved by consensus. The primary outcome of interest was the relative risk of disease progression among patients with BE with low-grade dysplasia treated with RFAcompared with surveillance.RESULTS:Our search resulted in 2,029 citations, 19 studies were included in the final analysis, totaling 2,746 patients. Relative risk of disease progression in RFA compared with surveillance was 0.14% (95% confidence interval: 0.04–0.45), P=0.001. This measure was stable when only all studies were included. Absolute risk reduction was 10.9% and the number needed to treat was 9.2. Results were stable over several quality measures, overtime, and when excluding randomized trials. The cumulative rate of progression to high-grade dysplasia/EAC was lower in RFA compared with surveillance (1.7% vs. 12.6%, P<0.001).Conclusions:Similarly, the incidence rate of progression among patients with surveillance was significantly higher from those treated with RFA (0.022 vs. 0.005, P<0.001). RFA results in a significant reduction risk of disease progression to high-grade dysplasia/EAC among patients with BE with low-grade dysplasia.Am J Gastroenterol advance online publication, 4 April 2017; doi:10.1038/ajg.2017.70.

UR - http://www.scopus.com/inward/record.url?scp=85017144291&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85017144291&partnerID=8YFLogxK

U2 - 10.1038/ajg.2017.70

DO - 10.1038/ajg.2017.70

M3 - Article

C2 - 28374819

AN - SCOPUS:85017144291

JO - American Journal of Gastroenterology

JF - American Journal of Gastroenterology

SN - 0002-9270

ER -