Bashar J Qumseya1, Sachin Wani2, Madhav Desai3, Amira Qumseya4, Paul Bain5, Prateek Sharma3, Herbert Wolfsen6. 1. Division of Gastroenterology and Hepatology, Archbold Medical Group/Florida State University, Thomasville, Georgia. Electronic address: bqumseya@archbold.org. 2. Division of Gastroenterology and Hepatology, University of Colorado Anschutz Medical Campus, Aurora, Colorado. 3. Division of Gastroenterology and Hepatology, Veterans Affairs Medical Center and University of Kansas School of Medicine, Kansas City, Kansas. 4. Department of Biostatistics, Florida State University, Tallahassee, Florida. 5. Harvard School of Public Health, Boston, Massachusetts. 6. Division of Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, Florida.
Abstract
BACKGROUND & AIMS: Radiofrequency ablation (RFA) with or without endoscopic mucosal resection (EMR) is routinely used for treatment of Barrett's esophagus with dysplasia. Despite the relative safety of this method, there have been imprecise estimates of the rate of adverse events. We performed a systematic review and meta-analysis to assess the rate of adverse events associated with RFA with and without EMR. METHODS: We searched MEDLINE, Embase, Web of Science, and Cochrane Central through October 22, 2014. The primary outcome of interest was the overall rate of adverse events after RFA with or without EMR. We used forest plots to contrast effect sizes among studies. RESULTS: Of 1521 articles assessed, 37 met our inclusion criteria (comprising 9200 patients). The pooled rate of all adverse events from RFA with or without EMR was 8.8% (95% confidence interval [CI], 6.5%-11.9%); 5.6% of patients developed strictures (95% CI, 4.2%-7.4%), 1% had bleeding (95% CI, 0.8%-1.3%), and 0.6% developed a perforation (95% CI, 0.4%-0.9%). In studies that compared RFA with vs without EMR, the relative risk for adverse events was significantly higher for RFA with EMR (4.4) (P = .015). There was a trend toward higher proportions of adverse events in prospective studies compared with retrospective studies (11.3% vs 7.8%, P = .20). Other factors associated with adverse events included Barrett's esophagus and length and baseline histology. CONCLUSIONS: In a systematic review and meta-analysis, we found the relative risk for adverse events from RFA to be about 4-fold higher with EMR than without; we identified factors associated with these events. Endoscopists should discuss these risks with patients before endoscopic eradication therapy.
BACKGROUND & AIMS: Radiofrequency ablation (RFA) with or without endoscopic mucosal resection (EMR) is routinely used for treatment of Barrett's esophagus with dysplasia. Despite the relative safety of this method, there have been imprecise estimates of the rate of adverse events. We performed a systematic review and meta-analysis to assess the rate of adverse events associated with RFA with and without EMR. METHODS: We searched MEDLINE, Embase, Web of Science, and Cochrane Central through October 22, 2014. The primary outcome of interest was the overall rate of adverse events after RFA with or without EMR. We used forest plots to contrast effect sizes among studies. RESULTS: Of 1521 articles assessed, 37 met our inclusion criteria (comprising 9200 patients). The pooled rate of all adverse events from RFA with or without EMR was 8.8% (95% confidence interval [CI], 6.5%-11.9%); 5.6% of patients developed strictures (95% CI, 4.2%-7.4%), 1% had bleeding (95% CI, 0.8%-1.3%), and 0.6% developed a perforation (95% CI, 0.4%-0.9%). In studies that compared RFA with vs without EMR, the relative risk for adverse events was significantly higher for RFA with EMR (4.4) (P = .015). There was a trend toward higher proportions of adverse events in prospective studies compared with retrospective studies (11.3% vs 7.8%, P = .20). Other factors associated with adverse events included Barrett's esophagus and length and baseline histology. CONCLUSIONS: In a systematic review and meta-analysis, we found the relative risk for adverse events from RFA to be about 4-fold higher with EMR than without; we identified factors associated with these events. Endoscopists should discuss these risks with patients before endoscopic eradication therapy.
Authors: Sachin Wani; V Raman Muthusamy; Nicholas J Shaheen; Rena Yadlapati; Robert Wilson; Julian A Abrams; Jacques Bergman; Amitabh Chak; Kenneth Chang; Ananya Das; John Dumot; Steven A Edmundowicz; Glenn Eisen; Gary W Falk; M Brian Fennerty; Lauren Gerson; Gregory G Ginsberg; David Grande; Matt Hall; Ben Harnke; John Inadomi; Janusz Jankowski; Charles J Lightdale; Jitin Makker; Robert D Odze; Oliver Pech; Richard E Sampliner; Stuart Spechler; George Triadafilopoulos; Michael B Wallace; Kenneth Wang; Irving Waxman; Srinadh Komanduri Journal: Am J Gastroenterol Date: 2017-06-01 Impact factor: 10.864
Authors: Swathi Eluri; Athidi G Earasi; Susan E Moist; Evan S Dellon; Nicholas J Shaheen Journal: Clin Gastroenterol Hepatol Date: 2019-05-08 Impact factor: 11.382