Mo1260 OUTCOMES OF RADIOFREQUENCY ABLATION VS ENDOSCOPIC SURVEILLANCE FOR BARRETTS ESOPHAGUS WITH LOW-GRADE DYSPLASIA: A SYTEMATIC REVIEW AND META-ANALYSIS

Abstract

Endoscopic therapy using radiofrequency ablation (RFA) is the current standard of care for management of Barrett’s esophagus with high grade dysplasia (BE-HGD). However, currently there is no consensus on the management of BE with low grade dysplasia (BE-LGD) – RFA vs endoscopic surveillance. Recently published studies have compared these two management strategies for BE-LGD. Hence, we performed a systematic review and meta-analysis of these comparative studies to compare the risk of progression to high grade dysplasia or esophageal adenocarcinoma (EAC) among patients with BE-LGD treated with RFA vs endoscopic surveillance. We conducted a comprehensive search of multiple electronic databases and conference proceedings (from inception through August 2019) to identify studies comparing RFA vs endoscopic surveillance for management of patients with BE-LGD. Two independent reviewers extracted the data. The primary outcome was to compare the risk of progression to HGD or EAC among patients with BE-LGD treated with RFA vs endoscopic surveillance. The secondary outcomes were to compare the risk of progression to HGD alone and EAC alone between the two groups. Four comparative studies reporting a total of 543 patients with BE-LGD were included in the meta-analysis (234 in RFA and 309 in endoscopic surveillance). The progression of BE-LGD to either HGD or EAC was significantly lower in patients treated with RFA compared to endoscopic surveillance (OR: 0.17, 95% CI: 0.04-0.65, p=0.01), Table 1. The progression to HGD alone was significantly lower in patients treated with RFA vs endoscopic surveillance (OR: 0.23, 95% CI: 0.08-0.61, p=0.003), Table 1. The progression to EAC alone was numerically lower in RFA compared to endoscopic surveillance without statistical significance (OR: 0.45, 95% CI: 0.17-1.19, p=0.11), Table 1. Low heterogeneity was noted in the analysis. Based on our meta-analysis, there was a significant reduction in the risk of progression to HGD or EAC among patients with BE-LGD treated with RFA compared with those undergoing endoscopic surveillance. Endoscopic eradication therapy with RFA should be the preferred management approach for BE-LGD.