Mo1268 EFFICACY AND SAFETY OF ARGON PLASMA COAGULATION AND RADIOFREQUENCY ABLATION IN THE MANAGEMENT OF SYMPTOMATIC CERVICAL INLET PATCH: SYSTEMATIC REVIEW AND META-ANALYSIS

Abstract

Cervical inlet patch or heterotopic gastric mucosa is a common incidental finding on upper endoscopy and is often asymptomatic. However, it can cause symptoms such as globus, cough and hoarseness which can be unresponsive to treatment with proton pump inhibitors (PPI). Some studies have evaluated the role of argon plasma coagulation (APC) and radiofrequency ablation (RFA) in the management of symptomatic cervical inlet patch. To evaluate the efficacy and safety of APC and RFA in the management of symptomatic cervical inlet patch by systematic review and meta-analysis. We conducted a systematic search on PubMed, Scopus, Web of Science and Cochrane library from inception to November 2019 to identify studies evaluating the efficacy and safety of APC and RFA in the management of patients with symptomatic cervical inlet patch with no improvement of symptoms with PPI treatment. Our outcomes of interest were clinical success (defined by improvement of symptoms after treatment), macroscopic eradication (confirmed by follow-up endoscopy after treatment), histologic eradication (defined by absence of intestinal metaplasia on biopsy specimens on follow-up endoscopy) and major adverse events. Weighted pooled rates (WPRs) were calculated for the outcomes of interest and analyzed using random effects model. Heterogeneity was assessed using I2 statistic. We included 6 studies with 90 patients, 5 were observational and one was RCT. 2 studies with 20 patients evaluated the use of RFA and 4 studies with 70 patients evaluated the use of APC. WPRs (95% CI) for clinical success with RFA and APC were 91% (66%, 98%), I2=0% and 75% (63%, 84%), I2=0% respectively (Figure 1A and B). WPRs (95% CI) for macroscopic eradication with RFA and APC were 86% (60%, 96%), I2=1% and 82% (12%, 99%), I2=82% (Figure 2A and B). WPR (95% CI) for histologic eradication with RFA were 86% (60%, 96%), I2=1%. There were no major adverse events with both treatments. RFA and APC are safe and effective in the management of symptomatic cervical inlet patch. RFA appears to be better compared to APC. More studies are required to confirm these findings.View Large Image Figure ViewerDownload Hi-res image Download (PPT)