Treatment of high-grade dysplasia and intramucosal carcinoma using radiofrequency ablation or endoscopic mucosal resection + radiofrequency ablation: Meta-analysis and systematic review

作     者：Mileine Valente de Matos Alberto Machado da Ponte-Neto Diogo Turiani Hourneaux de Moura Ethan Dwane Maahs Dalton Marques Chaves Elisa Ryoka Baba Edson Ide Rubens Sallum Wanderley Marques Bernardo Eduardo Guimar?es Hourneaux de Moura 

作者机构：Gastrointestinal Endoscopy Unit Gastroenterology Department University of Sao Paulo School of Medicine Genetics Genomics and Development (Molecular and Cell Biology)Department University of California Berkeley Gastrointestinal Surgery Gastroenterology Department University of Sao Paulo School of Medicine Thoracic Surgery Department Instituto do Coracao (InCorHeart Institute) University of Sao Paulo School of Medicine 

出 版 物：《World Journal of Gastrointestinal Endoscopy》 (世界胃肠内镜杂志（英文版）（电子版）)

年 卷 期：2019年第11卷第3期

页      面：239-248页

学科分类：1002[医学-临床医学] 100214[医学-肿瘤学] 10[医学] 

主　　题：Barrett esophagus Radiofrequency Endoscopic mucosal resection HALO system 

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 *** To compare the effectiveness of radiofrequency ablation(RFA) vs endoscopic mucosal resection(EMR) + RFA in the endoscopic treatment of HGD and intramucosal *** 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 *** 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 *** 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.