Mo1285 SAFETY AND EFFICACY OF MULTIBAND MUCOSECTOMY AND ENDOSCOPIC CAP RESECTION IN EARLY BARRETT’S NEOPLASIA: A SYSTEMATIC REVIEW AND META-ANALYSIS

Abstract

Endoscopic cap resection (CAP-R) and Multiband mucosectomy (MBM) are the two most commonly used endoscopic mucosal resection (EMR) procedures for early Barrett’s neoplasia. MBM is a newer method of EMR that does not require submucosal lifting and is technically easier to perform that CAP-R. We performed a systematic review and meta-analysis to compare the overall safety and efficacy of both these procedures for early Barrett’s neoplasia. 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 Oct 2019) to identify the studies reporting use of MBM and CAP-R for early Barrett’s neoplasia. The primary outcome was to evaluate the technical success of the procedures 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 procedures. The meta-analysis was performed using Der Simonian and Laird random effect model. 15 studies (N=1176 and no. of lesions=1487) reporting on MBM and 15 studies (N=653 and no. of lesions=785) reporting on CAP-R were included in our final analysis. The mean age was 64 years and 61.8 years in MBM group and CAP-R group respectively. The pooled technical success rates were 99.1% (95% CI 96.76-100, I2=81.51) in MBM group versus 94.2% (95% CI 84.61-99.69, I2=93.45) in CAP -R group with p-value of 0.139. (Table 1) The total early adverse event rates were 9.41% (95% CI 1.97-20.39, I2= 292.37) in CAP-R group versus 5.87% (95% CI 2.61-10.02, I2=78.26) in MBM group with p-value of 0.458. (Table 2) The most common early adverse events were bleeding with 5.09% (95% CI 1.97-9.19, I2=79.59) in MBM group and 5.95% (95% CI 2.47-10.46, I2=92.7) in CAP-R group. The most common delayed adverse events were stricture formation with 10.99% (95% CI 5.67-17.53, I2=86.84) in MBM group and 3.03% (95% CI 0.39-7.2, I2=74.88) in CAP-R group. The mean procedure time for MBM was shorter (23.3 min; reported in six studies) as compared to CAP-R (29.31 min; reported in six studies). Significant heterogeneity was noted in in our meta-analysis. Although in our study, MBM had similar pooled technical success rate as CAP-R in early Barrett’s neoplasia (p-value =0.139) but procedure times were shorter as compared to CAP-R. Further large multicenter randomized controlled trials are needed for further validation of our findings.Table 2Forest Plot showing overall early adverse events of MBM and CAP-RView Large Image Figure ViewerDownload Hi-res image Download (PPT)