399 Safety and Efficacy of Multiband Mucosectomy in Early Barrett's Neoplasia: A Systematic Review and Meta-Analysis

Abstract

INTRODUCTION: Endoscopic mucosal resection (EMR) is treatment of choice for early Barrett’s neoplasia. Multiband mucosectomy (MBM) is a type of EMR procedure used for diagnosis and treatment of early Barrett’s neoplasia. This procedure has an advantage over cap-resection as it does not require submucosal lifting. We performed systematic review and meta-analysis to compare the overall safety and efficacy of this procedure for early Barrett’s neoplasia. METHODS: We conducted a comprehensive search of multiple electronic databases and conference proceedings including PubMed, EMBASE, Web of Science databases, Google Scholar and manual search of references (from inception through May 2019) to identify the studies reporting use of MBM for early Barrett’s neoplasia. The primary outcome was to evaluate the technical success of the procedure which was defined as complete endoscopic resection of a delineated focal lesion. The secondary outcome was to study overall, early and delayed adverse events related to the procedure. The meta-analysis was performed using Der Simonian and Laird random effect model. RESULTS: 15 studies reporting on 1197 patients with 1487 lesions were included. Majority of the patient population were males (80.8%), with mean age of 64 years. The pooled technical success rates were 99.1% (95% CI 96.76-100, I2 = 81.51) and the total early adverse event rates were 5.87% (95% CI 2.61-10.02, I2 = 78.26). The most common early and delayed adverse events were bleeding (5.09%; 95% CI 1.97-9.19, I2 = 79.59) and strictures (10.99%; 95% CI 5.67-17.53, I2 = 86.84) respectively. Total 5 perforations were reported in our patient population. The mean procedure time was 23.3 min reported in six studies. Significant heterogeneity was noted in in our meta-analysis. CONCLUSION: Multiband mucosectomy is a safe alternative procedure to endoscopic cap resection for the treatment of early Barrett’s neoplasia with high technical success and lower adverse events. Further large multicenter randomized controlled trials are needed for further validation of our findings.