Endoscopic mucosal resection plus radiofrequency ablation safest for Barrett’s esophagus
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Endoscopic mucosal resection followed by radiofrequency ablation had a better safety profile for managing Barrett’s esophagus than endoscopic mucosal resection and stepwise/complete endoscopic mucosal resection, according to a presentation at the ACG virtual annual meeting.
“There was no difference in recurrence of neoplasia with any endoscopic modality. However, [endoscopic mucosal resection followed by radiofrequency ablation (EMR+RFA)] was associated with lower risk of perforation as compared to [endoscopic mucosal resection (ESD)] and lower risk of stricture formation and bleeding as compared to [stepwise/complete endoscopic mucosal resection (sEMR)],” Saeed Ali, MD, from the University of Iowa Hospitals and Clinics, said during his presentation.
In a systematic review and metanalysis, Ali and colleagues identified 37 studies with 2,377 patients that evaluated the efficacy and safety of endoscopic submuscosal dissection, endoscopic mucosal resection followed by radiofrequency ablation and stepwise/complete endoscopic mucosal resection for the management of Barrett’s esophagus due to early neoplasia.
Recurrence of high-grade dysplasia or early adenocarcinoma, with risk for strictures, perforation and bleeding served as the primary outcomes. Other outcomes included en bloc and Ro resections for endoscopic submucosal dissection, complete eradication of neoplasia for endoscopic mucosal resection followed by radiofrequency ablation and stepwise/complete endoscopic mucosal resection. Investigators calculated the weighted pooled rates for each outcome and proportionate difference to compare the endoscopic modalities.
Data showed the weighed pooled rate for recurrence of endoscopic submucosal dissection was 10.3%; 5% for endoscopic mucosal resection followed by radiofrequency ablation and 7.4% for stepwise/complete endoscopic mucosal resection. Investigators reported no difference in recurrence among any endoscopic modality (P > .05).
During follow-up, the weighted pooled rate for strictures was 9.5% for endoscopic submucosal dissection, 11.5% for endoscopic mucosal resection followed by radiofrequency ablation and 29% for stepwise/complete endoscopic mucosal resection. Endoscopic submucosal dissection and endoscopic mucosal resection followed by radiofrequency ablation correlated with lower stricture formation compared with stepwise/complete endoscopic mucosal resection (P < .05). However, no difference was observed in stricture formation between endoscopic submucosal dissection and endoscopic mucosal resection followed by radiofrequency ablation. The weighted pooled rate for bleeding was 3.5% for endoscopic mucosal resection, 3% for endoscopic mucosal resection followed by radiofrequency ablation and 6% for stepwise/complete endoscopic mucosal resection.
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Ali S, et al. Abstract: S0903. Presented at the American College of Gastroenterology Annual Scientific Meeting (Virtual). Oct. 23-28, 2020.
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