Treatment of high-grade dysplasia and intramucosal carcinoma using radiofrequency ablation or endoscopic mucosal resection + radiofrequency ablation: Meta-analysis and systematic review
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摘要
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, with742 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.
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, with742 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.
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, with742 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.
引文
1 Phillips WA,Lord RV,Nancarrow DJ,Watson DI,Whiteman DC.Barrett's esophagus.J Gastroenterol Hepatol 2011;26:639-648[PMID:21166712 DOI:10.1111/j.1440-1746.2010.06602.x]
2 Lenglinger J,Riegler M,Cosentini E,Asari R,Mesteri I,Wrba F,Schoppmann SF.Review on the annual cancer risk of Barrett's esophagus in persons with symptoms of gastroesophageal reflux disease.Anticancer Res 2012;32:5465-5473[PMID:23225453]
3 Phoa KN,van Vilsteren FG,Weusten BL,Bisschops R,Schoon EJ,Ragunath K,Fullarton G,Di Pietro M,Ravi N,Visser M,Offerhaus GJ,Seldenrijk CA,Meijer SL,ten Kate FJ,Tijssen JG,Bergman JJ.Radiofrequency ablation vs endoscopic surveillance for patients with Barrett esophagus and low-grade dysplasia:a randomized clinical trial.JAMA 2014;311:1209-1217[PMID:24668102 DOI:10.1001/jama.2014.2511]
4 Chadwick G,Groene O,Markar SR,Hoare J,Cromwell D,Hanna GB.Systematic review comparing radiofrequency ablation and complete endoscopic resection in treating dysplastic Barrett's esophagus:a critical assessment of histologic outcomes and adverse events.Gastrointest Endosc 2014;79:718-731.e3[PMID:24462170 DOI:10.1016/j.gie.2013.11.030]
5 Terheggen G,Horn EM,Vieth M,Gabbert H,Enderle M,Neugebauer A,Schumacher B,Neuhaus H.Arandomised trial of endoscopic submucosal dissection versus endoscopic mucosal resection for early Barrett's neoplasia.Gut 2017;66:783-793[PMID:26801885 DOI:10.1136/gutjnl-2015-310126]
6 Sharma VK,Wang KK,Overholt BF,Lightdale CJ,Fennerty MB,Dean PJ,Pleskow DK,Chuttani R,Reymunde A,Santiago N,Chang KJ,Kimmey MB,Fleischer DE.Balloon-based,circumferential,endoscopic radiofrequency ablation of Barrett's esophagus:1-year follow-up of 100 patients.Gastrointest Endosc 2007;65:185-195[PMID:17258973 DOI:10.1016/j.gie.2006.09.033]
7 Sharma VK,Kim HJ,Das A,Dean P,DePetris G,Fleischer DE.A prospective pilot trial of ablation of Barrett's esophagus with low-grade dysplasia using stepwise circumferential and focal ablation(HALOsystem).Endoscopy 2008;40:380-387[PMID:18459074 DOI:10.1055/s-2007-995587]
8 Liberati A,Altman DG,Tetzlaff J,Mulrow C,G?tzsche PC,Ioannidis JP,Clarke M,Devereaux PJ,Kleijnen J,Moher D.The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions:explanation and elaboration.J Clin Epidemiol 2009;62:e1-34[PMID:19631507 DOI:10.1016/j.jclinepi.2009.06.006]
9 Wells GA,Shea B,O’connell D,Peterson JE,Welch V,Losos M,Tugwell P.The Newcastle-Ottawa Scale(NOS)for assessing the quality of nonrandomised studies in meta-analyses.Available from:http://www.ohri.ca/programs/clinical_epidemiology/oxford.asp
10 Li N,Pasricha S,Bulsiewicz WJ,Pruitt RE,Komanduri S,Wolfsen HC,Chmielewski GW,Corbett FS,Chang KJ,Shaheen NJ.Effects of preceding endoscopic mucosal resection on the efficacy and safety of radiofrequency ablation for treatment of Barrett's esophagus:results from the United States Radiofrequency Ablation Registry.Dis Esophagus 2016;29:537-543[PMID:26121935 DOI:10.1111/dote.12386]
11 Strauss AC,Agoston AT,Dulai PS,Srivastava A,Rothstein RI.Radiofrequency ablation for Barrett'sassociated intramucosal carcinoma:a multi-center follow-up study.Surg Endosc 2014;28:3366-3372[PMID:24950726 DOI:10.1007/s00464-014-3629-0]
12 Haidry RJ,Dunn JM,Butt MA,Burnell MG,Gupta A,Green S,Miah H,Smart HL,Bhandari P,Smith LA,Willert R,Fullarton G,Morris J,Di Pietro M,Gordon C,Penman I,Barr H,Patel P,Boger P,Kapoor N,Mahon B,Hoare J,Narayanasamy R,O'Toole D,Cheong E,Direkze NC,Ang Y,Novelli M,Banks MR,Lovat LB.Radiofrequency ablation and endoscopic mucosal resection for dysplastic barrett's esophagus and early esophageal adenocarcinoma:outcomes of the UK National Halo RFA Registry.Gastroenterology 2013;145:87-95[PMID:23542069 DOI:10.1053/j.gastro.2013.03.045]
13 Phoa KN,Pouw RE,van Vilsteren FGI,Sondermeijer CMT,Ten Kate FJW,Visser M,Meijer SL,van Berge Henegouwen MI,Weusten BLAM,Schoon EJ,Mallant-Hent RC,Bergman JJGHM.Remission of Barrett's esophagus with early neoplasia 5 years after radiofrequency ablation with endoscopic resection:a Netherlands cohort study.Gastroenterology 2013;145:96-104[PMID:23542068 DOI:10.1053/j.gastro.2013.03.046]
14 Kim HP,Bulsiewicz WJ,Cotton CC,Dellon ES,Spacek MB,Chen X,Madanick RD,Pasricha S,Shaheen NJ.Focal endoscopic mucosal resection before radiofrequency ablation is equally effective and safe compared with radiofrequency ablation alone for the eradication of Barrett's esophagus with advanced neoplasia.Gastrointest Endosc 2012;76:733-739[PMID:22732872 DOI:10.1016/j.gie.2012.04.459]
15 Caillol F,Bories E,Pesenti C,Poizat F,Monges G,Guiramand J,Esterni B,Giovannini M.Radiofrequency ablation associated to mucosal resection in the oesophagus:experience in a single centre.Clin Res Hepatol Gastroenterol 2012;36:371-377[PMID:22361442 DOI:10.1016/j.clinre.2012.01.004]
16 Okoro NI,Tomizawa Y,Dunagan KT,Lutzke LS,Wang KK,Prasad GA.Safety of prior endoscopic mucosal resection in patients receiving radiofrequency ablation of Barrett's esophagus.Clin Gastroenterol Hepatol 2012;10:150-154[PMID:22056303 DOI:10.1016/j.cgh.2011.10.030]
17 Pouw RE,Gondrie JJ,Sondermeijer CM,ten Kate FJ,van Gulik TM,Krishnadath KK,Fockens P,Weusten BL,Bergman JJ.Eradication of Barrett esophagus with early neoplasia by radiofrequency ablation,with or without endoscopic resection.J Gastrointest Surg 2008;12:1627-36;discussion 1636-7[PMID:18704598 DOI:10.1007/s11605-008-0629-1]
18 Qumseya BJ,Wani S,Desai M,Qumseya A,Bain P,Sharma P,Wolfsen H.Adverse Events After Radiofrequency Ablation in Patients With Barrett's Esophagus:A Systematic Review and Meta-analysis.Clin Gastroenterol Hepatol 2016;14:1086-1095.e6[PMID:27068041 DOI:10.1016/j.cgh.2016.04.001]
19 Qumseya BJ,Wani S,Gendy S,Harnke B,Bergman JJ,Wolfsen H.Disease Progression in Barrett's LowGrade Dysplasia With Radiofrequency Ablation Compared With Surveillance:Systematic Review and Meta-Analysis.Am J Gastroenterol 2017;112:849-865[PMID:28374819 DOI:10.1038/ajg.2017.70]
20 Gray NA,Odze RD,Spechler SJ.Buried metaplasia after endoscopic ablation of Barrett's esophagus:a systematic review.Am J Gastroenterol 2011;106:1899-908;quiz 1909[PMID:21826111 DOI:10.1038/ajg.2011.255]
2 Lenglinger J,Riegler M,Cosentini E,Asari R,Mesteri I,Wrba F,Schoppmann SF.Review on the annual cancer risk of Barrett's esophagus in persons with symptoms of gastroesophageal reflux disease.Anticancer Res 2012;32:5465-5473[PMID:23225453]
3 Phoa KN,van Vilsteren FG,Weusten BL,Bisschops R,Schoon EJ,Ragunath K,Fullarton G,Di Pietro M,Ravi N,Visser M,Offerhaus GJ,Seldenrijk CA,Meijer SL,ten Kate FJ,Tijssen JG,Bergman JJ.Radiofrequency ablation vs endoscopic surveillance for patients with Barrett esophagus and low-grade dysplasia:a randomized clinical trial.JAMA 2014;311:1209-1217[PMID:24668102 DOI:10.1001/jama.2014.2511]
4 Chadwick G,Groene O,Markar SR,Hoare J,Cromwell D,Hanna GB.Systematic review comparing radiofrequency ablation and complete endoscopic resection in treating dysplastic Barrett's esophagus:a critical assessment of histologic outcomes and adverse events.Gastrointest Endosc 2014;79:718-731.e3[PMID:24462170 DOI:10.1016/j.gie.2013.11.030]
5 Terheggen G,Horn EM,Vieth M,Gabbert H,Enderle M,Neugebauer A,Schumacher B,Neuhaus H.Arandomised trial of endoscopic submucosal dissection versus endoscopic mucosal resection for early Barrett's neoplasia.Gut 2017;66:783-793[PMID:26801885 DOI:10.1136/gutjnl-2015-310126]
6 Sharma VK,Wang KK,Overholt BF,Lightdale CJ,Fennerty MB,Dean PJ,Pleskow DK,Chuttani R,Reymunde A,Santiago N,Chang KJ,Kimmey MB,Fleischer DE.Balloon-based,circumferential,endoscopic radiofrequency ablation of Barrett's esophagus:1-year follow-up of 100 patients.Gastrointest Endosc 2007;65:185-195[PMID:17258973 DOI:10.1016/j.gie.2006.09.033]
7 Sharma VK,Kim HJ,Das A,Dean P,DePetris G,Fleischer DE.A prospective pilot trial of ablation of Barrett's esophagus with low-grade dysplasia using stepwise circumferential and focal ablation(HALOsystem).Endoscopy 2008;40:380-387[PMID:18459074 DOI:10.1055/s-2007-995587]
8 Liberati A,Altman DG,Tetzlaff J,Mulrow C,G?tzsche PC,Ioannidis JP,Clarke M,Devereaux PJ,Kleijnen J,Moher D.The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions:explanation and elaboration.J Clin Epidemiol 2009;62:e1-34[PMID:19631507 DOI:10.1016/j.jclinepi.2009.06.006]
9 Wells GA,Shea B,O’connell D,Peterson JE,Welch V,Losos M,Tugwell P.The Newcastle-Ottawa Scale(NOS)for assessing the quality of nonrandomised studies in meta-analyses.Available from:http://www.ohri.ca/programs/clinical_epidemiology/oxford.asp
10 Li N,Pasricha S,Bulsiewicz WJ,Pruitt RE,Komanduri S,Wolfsen HC,Chmielewski GW,Corbett FS,Chang KJ,Shaheen NJ.Effects of preceding endoscopic mucosal resection on the efficacy and safety of radiofrequency ablation for treatment of Barrett's esophagus:results from the United States Radiofrequency Ablation Registry.Dis Esophagus 2016;29:537-543[PMID:26121935 DOI:10.1111/dote.12386]
11 Strauss AC,Agoston AT,Dulai PS,Srivastava A,Rothstein RI.Radiofrequency ablation for Barrett'sassociated intramucosal carcinoma:a multi-center follow-up study.Surg Endosc 2014;28:3366-3372[PMID:24950726 DOI:10.1007/s00464-014-3629-0]
12 Haidry RJ,Dunn JM,Butt MA,Burnell MG,Gupta A,Green S,Miah H,Smart HL,Bhandari P,Smith LA,Willert R,Fullarton G,Morris J,Di Pietro M,Gordon C,Penman I,Barr H,Patel P,Boger P,Kapoor N,Mahon B,Hoare J,Narayanasamy R,O'Toole D,Cheong E,Direkze NC,Ang Y,Novelli M,Banks MR,Lovat LB.Radiofrequency ablation and endoscopic mucosal resection for dysplastic barrett's esophagus and early esophageal adenocarcinoma:outcomes of the UK National Halo RFA Registry.Gastroenterology 2013;145:87-95[PMID:23542069 DOI:10.1053/j.gastro.2013.03.045]
13 Phoa KN,Pouw RE,van Vilsteren FGI,Sondermeijer CMT,Ten Kate FJW,Visser M,Meijer SL,van Berge Henegouwen MI,Weusten BLAM,Schoon EJ,Mallant-Hent RC,Bergman JJGHM.Remission of Barrett's esophagus with early neoplasia 5 years after radiofrequency ablation with endoscopic resection:a Netherlands cohort study.Gastroenterology 2013;145:96-104[PMID:23542068 DOI:10.1053/j.gastro.2013.03.046]
14 Kim HP,Bulsiewicz WJ,Cotton CC,Dellon ES,Spacek MB,Chen X,Madanick RD,Pasricha S,Shaheen NJ.Focal endoscopic mucosal resection before radiofrequency ablation is equally effective and safe compared with radiofrequency ablation alone for the eradication of Barrett's esophagus with advanced neoplasia.Gastrointest Endosc 2012;76:733-739[PMID:22732872 DOI:10.1016/j.gie.2012.04.459]
15 Caillol F,Bories E,Pesenti C,Poizat F,Monges G,Guiramand J,Esterni B,Giovannini M.Radiofrequency ablation associated to mucosal resection in the oesophagus:experience in a single centre.Clin Res Hepatol Gastroenterol 2012;36:371-377[PMID:22361442 DOI:10.1016/j.clinre.2012.01.004]
16 Okoro NI,Tomizawa Y,Dunagan KT,Lutzke LS,Wang KK,Prasad GA.Safety of prior endoscopic mucosal resection in patients receiving radiofrequency ablation of Barrett's esophagus.Clin Gastroenterol Hepatol 2012;10:150-154[PMID:22056303 DOI:10.1016/j.cgh.2011.10.030]
17 Pouw RE,Gondrie JJ,Sondermeijer CM,ten Kate FJ,van Gulik TM,Krishnadath KK,Fockens P,Weusten BL,Bergman JJ.Eradication of Barrett esophagus with early neoplasia by radiofrequency ablation,with or without endoscopic resection.J Gastrointest Surg 2008;12:1627-36;discussion 1636-7[PMID:18704598 DOI:10.1007/s11605-008-0629-1]
18 Qumseya BJ,Wani S,Desai M,Qumseya A,Bain P,Sharma P,Wolfsen H.Adverse Events After Radiofrequency Ablation in Patients With Barrett's Esophagus:A Systematic Review and Meta-analysis.Clin Gastroenterol Hepatol 2016;14:1086-1095.e6[PMID:27068041 DOI:10.1016/j.cgh.2016.04.001]
19 Qumseya BJ,Wani S,Gendy S,Harnke B,Bergman JJ,Wolfsen H.Disease Progression in Barrett's LowGrade Dysplasia With Radiofrequency Ablation Compared With Surveillance:Systematic Review and Meta-Analysis.Am J Gastroenterol 2017;112:849-865[PMID:28374819 DOI:10.1038/ajg.2017.70]
20 Gray NA,Odze RD,Spechler SJ.Buried metaplasia after endoscopic ablation of Barrett's esophagus:a systematic review.Am J Gastroenterol 2011;106:1899-908;quiz 1909[PMID:21826111 DOI:10.1038/ajg.2011.255]