A Systematic Review and Meta-Analysis of the Treatment for Barrett’s Esophagus

Abstract

As evidence-based strategies to the clinical management of Barrett's esophagus (BE) are lacking, we have carried out a systematic review and meta-analysis of all published randomized controlled trials with the aim of evaluating the value of different approaches in the treatment of BE. Searches were conducted in the databases PUBMED, EMBASE, and Cochrane Library. Thirteen randomized clinical trials that fulfilled the inclusion criteria and addressed the clinical questions of this analysis were assessed in more detail. Based on our search, neither the pharmacological nor surgical therapies currently available for reflux appear to achieve complete regression of BE and the elimination of the cancer risk associated with it. In contrast, endoscopic ablative techniques are capable of achieving endoscopic and histological reversal of BE, with ablation by argon plasma coagulation (APC) appearing to be more effective than treatment with photodynamic therapy (PDT) [odds ratio (OR) 3.46, 95% confidence interval (CI) 1.67-7.81, P = 0.0008]. There was no statistically significant difference between APC and multipolar electrocoagulation (MPEC) in terms of the efficacy to achieve regression of BE (OR 2.01, 95% CI 0.77-5.23, P = 0.15). In conclusion, there have been only a limited number of randomized controlled trials that compare treatments for BE. The pharmacological therapy, antireflux surgery, and endoscopic ablative techniques are promising in terms of treating BE, but the studies carried out to date have had no adequate power to assess the effect of treatment on reducing and preventing progression to adenocarcinoma.

Update on management of Barrett's esophagus

“…Cryotherapy has not been assessed in randomized controlled trials, and it is not currently indicated as an alternative endoscopic eradication therapy. Small randomized controlled trials using argon plasma coagulation have reported anecdotal highsuccess rates [67] . In the case of an early EA extending into the submucosal layer, surgery should be considered as the best option [29] , since in T1a context the rate of lymph node involvement is extremely low (< 3%) but the risk increases up to 20%25% when the submucosal layer is affected.…”

A systematic review of the evidence for radiofrequency ablation for Barrett’s esophagus

“…Furthermore, due to the lack of data, it remains unclear whether these strictures appeared only in patients with additional EMR. An indirect comparison between RFA and other endoscopic treatments such as photodynamic therapy, based on the data found in secondary literature [25,26], suggests less buried intestinal metaplasia and also less stenosis after treatment with the HALO system. Similar results of such a comparison also were presented in a conference paper in 2008 [27].…”

Is short-term therapy really sufficient to eradicate Helicobacter pylori infection?

“…The test for heterogeneity was analyzed by Cochrane's χ 2 -test (Wang et al, 2007), and when the Higgins I 2 statistic was ≤50%, which determines the percentage of total variation across studies due to heterogeneity (Wang et al, 2009), the fixed effect model was used to pool studies; otherwise, the random effect model was used. P<0.10 was considered to be significant for heterogeneity between studies (Li et al, 2008). When three or more study arms in a same trial were encountered, the similar pairs were extracted after the comparison of one short-term arm with one 7-d arm separately.…”

“…Three of 15 trials had clear and adequate allocation concealment. The use of concealed allocation should have limited patient selection bias in the current study (Li et al, 2008). Moreover, to predict the outcome of H. pylori eradication, the potential influencing factors should be analyzed jointly, which include characteristics of the population according to the geographical location, the prevalence of infection and microbial resistance, and the lead-time of reassessment.…”