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; Wolfsen, Herbert C.

doi:10.1038/ajg.2017.70

Cited by 79 publications

(56 citation statements)

References 32 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…The evidence for these outcomes was informed by 2 recent systematic reviews (see Table 6). 22,33 Qumseya et al 33 conducted a systematic review and meta-analysis comparing the risk of progression to HGD/EAC among BE patients with LGD treated with RFA compared with surveillance endoscopy using data from 22 studies of over 2500 patients. Three head-to-head studies (2 RCTs 16,17 and 1 retrospective 42 ) assessed the primary outcome of the RR of disease progression among patients treated with RFA compared with surveillance.…”

Section: Resultsmentioning

confidence: 99%

Endoscopic eradication therapy for patients with Barrett’s esophagus–associated dysplasia and intramucosal cancer

Wani¹,

Qumseya²,

Sultan³

et al. 2018

Gastrointestinal Endoscopy

Self Cite

138

View full text Add to dashboard Cite

Barrett's esophagus (BE) is defined by the replacement of the normal squamous epithelium of the distal esophagus with metaplastic intestinal-type columnar epithelium. 1-3 BE is an adverse event of chronic GERD and the only identifiable premalignant condition for esophageal adenocarcinoma (EAC), a cancer that continues to increase in incidence. In 2014 there were approximately 18,170 incident cases of esophageal cancer in the United States, nearly 60% of which were EAC. [4][5][6] Although uncommon, EAC is a highly lethal cancer associated with a poor 5year survival rate of 15% to 20% and an overall median survival of <1 year in cases with advanced disease. [5][6][7] It is estimated that BE is present in 1% to 2% of the general adult population. 8,9 The stepwise and hypothesized progression of BE to invasive EAC is believed to occur through the histopathologic stages of intestinal metaplasia to low-grade dysplasia (LGD) to high-grade dysplasia (HGD) to intramucosal EAC and finally to invasive EAC. 3,[10][11][12][13] Endoscopic eradication therapy (EET) has significantly changed the management of patients with BE-related neoplasia and allows a minimally invasive treatment approach that avoids the morbidity and mortality associated with esophagectomy. Contemporary EET, supported by published literature, entails endoscopic mucosal resection (EMR) of visible lesions within the Barrett's segment and ablative techniques that include radiofrequency ablation (RFA) and cryotherapy. Several studies, including randomized controlled trials (RCTs), large observational studies, and population-based studies, have demonstrated the efficacy, effectiveness, and safety of EET to achieve complete eradication of intestinal metaplasia (CE-IM) and neoplasia while maintaining disease remission. [14][15][16][17][18][19][20][21][22] In addition, population-based studies report comparable outcomes between esophagectomy and EET in the management of BE-related HGD and mucosal EAC. 23 Available data suggest that EET is being performed not only at academic and tertiary care centers but also among community practices. 14,18 AIMS/SCOPEThe aim of this document is to offer evidence-based recommendations and clinical guidelines addressing key issues related to EET in the management of BE-related neoplasia. This document addresses the following clinical questions: 1. What is the role of confirmation of diagnosis by an expert GI pathologist or by a panel of pathologists in BE patients with dysplasia or intramucosal EAC referred for EET? 2. Comparing EET with surveillance, what is the optimal management strategy in BE patients with dysplasia (HGD and LGD) and intramucosal EAC? 3. Comparing EET with esophagectomy, what is the optimal management strategy in BE patients with HGD and intramucosal EAC? 4. What is the role of EMR in BE patients with a visible lesion detected during screening or surveillance? 5. What is the role of ablation of the remaining BE segment after EMR of all visible lesions in BE patients referred for EET? 6. Comparing EMR of visibl...

show abstract

Section: Resultsmentioning

confidence: 99%

Endoscopic eradication therapy for patients with Barrett’s esophagus–associated dysplasia and intramucosal cancer

Wani¹,

Qumseya²,

Sultan³

et al. 2018

Gastrointestinal Endoscopy

Self Cite

138

View full text Add to dashboard Cite

show abstract

“…5 BE progresses to invasive EAC through stages of intestinal metaplasia (nondysplastic BE [NDBE]), low-grade dysplasia (LGD), to high-grade dysplasia (HGD), to intramucosal carcinoma, and finally to invasive EAC. 11 It is this step-wise progression in patients with BE and stagedependent survival in EAC that provides the impetus for screening and surveillance of BE. To ultimately impact the morbidity and mortality associated with EAC, several national and international medical societies recommend screening for BE in individuals with multiple risk factors and surveillance when the diagnosis of BE is established.…”

mentioning

confidence: 99%

ASGE guideline on screening and surveillance of Barrett’s esophagus

Qumseya¹,

Sultan

Bain

et al. 2019

Gastrointestinal Endoscopy

Self Cite

298

204

View full text Add to dashboard Cite

“…Three systematic reviews [58,71,72] Fewer patients progressed to higher grades of dysplasia with the radiofrequency ablation (RFA) treatment [low certainty] [58]. However, there is discrepancy in how this outcome is labelled in the review.…”

Section: Radiofrequency Ablation + Proton Pump Inhibitor Versus Ppi Amentioning

confidence: 99%

“…The text says there was no data for those progressing from IM to dysplasia and labels it as progression to higher grades of dysplasia, but the forest plot is titled progression from IM to dysplasia. When the outcome was restricted to progression to HGD among patients with LGD, no difference was observed [very low certainty] [71,72].…”

Section: Radiofrequency Ablation + Proton Pump Inhibitor Versus Ppi Amentioning

confidence: 99%

Screening for esophageal adenocarcinoma and precancerous conditions (dysplasia and Barrett’s esophagus) in patients with chronic gastroesophageal reflux disease with or without other risk factors: two systematic reviews and one overview of reviews to inform a guideline of the Canadian Task Force on Preventive Health Care (CTFPHC)

et al. 2020

View full text Add to dashboard Cite

Background: Two reviews and an overview were produced for the Canadian Task Force on Preventive Health Care guideline on screening for esophageal adenocarcinoma in patients with chronic gastroesophageal reflux disease (GERD) without alarm symptoms. The goal was to systematically review three key questions (KQs): (1) The effectiveness of screening for these conditions; (2) How adults with chronic GERD weigh the benefits and harms of screening, and what factors contribute to their preferences and decision to undergo screening; and (3) Treatment options for Barrett's esophagus (BE), dysplasia or stage 1 EAC (overview of reviews). Methods: Bibliographic databases (e.g. Ovid MEDLINE®) were searched for each review in October 2018. We also searched for unpublished literature (e.g. relevant websites). The liberal accelerated approach was used for title and abstract screening. Two reviewers independently screened full-text articles. Data extraction and risk of bias assessments were completed by one reviewer and verified by another reviewer (KQ1 and 2). Quality assessments were completed by two reviewers independently in duplicate (KQ3). Disagreements were resolved through discussion. We used various risk of bias tools suitable for study design. The GRADE framework was used for rating the certainty of the evidence.

show abstract

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

Cited by 79 publications

References 32 publications

Endoscopic eradication therapy for patients with Barrett’s esophagus–associated dysplasia and intramucosal cancer

Endoscopic eradication therapy for patients with Barrett’s esophagus–associated dysplasia and intramucosal cancer

ASGE guideline on screening and surveillance of Barrett’s esophagus

Contact Info

Product

Resources

About