Background and Aims

A small but significant proportion of patients with Barrett’s esophagus (BE) have persistent dysplasia or intestinal metaplasia (IM) after treatment with radiofrequency ablation (RFA). Cryotherapy is a cold-based ablative modality that is increasingly being used in this setting. We aimed to better understand the efficacy of second-line cryotherapy in patients with BE who have persistent dysplasia or IM after RFA by conducting a systematic review and meta-analysis.

Methods

We performed a systematic literature search of Pubmed, EMBASE, and Web of Science through September 1, 2017. Articles were included for meta-analysis based on the following inclusion criteria: ≥5 patients with BE treated with RFA had persistent dysplasia or IM; they subsequently underwent ≥1 session of cryotherapy with follow-up endoscopy; the proportions of patients achieving complete eradication of dysplasia (CE-D) and/or IM (CE-IM) were reported. The main outcomes were pooled proportions of CE-D and CE-IM by using a random effects model.

Results

Eleven studies making up 148 patients with BE treated with cryotherapy for persistent dysplasia or IM after RFA were included. The pooled proportion of CE-D was 76.0% (95% confidence interval [CI] 57.7-88.0), with substantial heterogeneity (I² = 62%). The pooled proportion of CE-IM was 45.9% (95% CI, 32.0-60.5) with moderate heterogeneity (I² = 57%). Multiple preplanned subgroup analyses did not sufficiently explain the heterogeneity. Adverse effects were reported in 6.7% of patients.

Conclusion

Cryotherapy successfully achieved CE-D in three fourths and CE-IM in half of patients with BE who did not respond to initial RFA. Considering its favorable safety profile, cryotherapy may be a viable second-line option for this therapeutically challenging cohort of patients with BE, but higher-quality studies validating this remain warranted.

中文翻译：

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射频消融术后持续性巴雷特食管的冷冻治疗：系统评价和荟萃分析

背景和目标

一小部分但显着比例的巴雷特食管 (BE) 患者在射频消融 (RFA) 治疗后出现持续性不典型增生或肠化生 (IM)。冷冻疗法是一种基于冷的消融方式，越来越多地在这种情况下使用。我们旨在通过系统评价和荟萃分析，更好地了解二线冷冻疗法对 RFA 后持续性不典型增生或 IM 患者的疗效。

方法

我们对截至 2017 年 9 月 1 日的 Pubmed、EMBASE 和 Web of Science 进行了系统的文献检索。根据以下纳入标准纳入文章进行荟萃分析：≥5 名接受 RFA 治疗的 BE 患者患有持续性不典型增生或 IM；他们随后接受了≥1次冷冻治疗并进行内窥镜检查；报告了完全根除不典型增生 (CE-D) 和/或 IM (CE-IM) 的患者比例。主要结果是使用随机效应模型得出的 CE-D 和 CE-IM 的汇总比例。

结果

纳入的 11 项研究涉及 148 名 BE 患者，这些患者因持续性不典型增生或 RFA 后接受冷冻疗法治疗 IM。CE-D 的汇总比例为 76.0%（95% 置信区间 [CI] 57.7-88.0），具有显着的异质性（I ²  = 62%）。CE-IM 的汇总比例为 45.9%（95% CI，32.0-60.5），具有中等异质性（I ²  = 57%）。多个预先计划的亚组分析并不能充分解释异质性。6.7% 的患者报告了不良反应。

结论

四分之三的冷冻疗法成功实现了 CE-D，一半对初始 RFA 无反应的 BE 患者成功实现了 CE-IM。考虑到其良好的安全性，冷冻疗法对于治疗上具有挑战性的 BE 患者群体来说可能是可行的二线选择，但仍然需要更高质量的研究来验证这一点。