Original article
Systematic reviews and meta-analyses
Adverse Events After Radiofrequency Ablation in Patients With Barrett’s Esophagus: A Systematic Review and Meta-analysis

https://doi.org/10.1016/j.cgh.2016.04.001Get rights and content

Background & Aims

Radiofrequency ablation (RFA) with or without endoscopic mucosal resection (EMR) is routinely used for treatment of Barrett’s esophagus with dysplasia. Despite the relative safety of this method, there have been imprecise estimates of the rate of adverse events. We performed a systematic review and meta-analysis to assess the rate of adverse events associated with RFA with and without EMR.

Methods

We searched MEDLINE, Embase, Web of Science, and Cochrane Central through October 22, 2014. The primary outcome of interest was the overall rate of adverse events after RFA with or without EMR. We used forest plots to contrast effect sizes among studies.

Results

Of 1521 articles assessed, 37 met our inclusion criteria (comprising 9200 patients). The pooled rate of all adverse events from RFA with or without EMR was 8.8% (95% confidence interval [CI], 6.5%–11.9%); 5.6% of patients developed strictures (95% CI, 4.2%–7.4%), 1% had bleeding (95% CI, 0.8%–1.3%), and 0.6% developed a perforation (95% CI, 0.4%–0.9%). In studies that compared RFA with vs without EMR, the relative risk for adverse events was significantly higher for RFA with EMR (4.4) (P = .015). There was a trend toward higher proportions of adverse events in prospective studies compared with retrospective studies (11.3% vs 7.8%, P = .20). Other factors associated with adverse events included Barrett’s esophagus and length and baseline histology.

Conclusions

In a systematic review and meta-analysis, we found the relative risk for adverse events from RFA to be about 4-fold higher with EMR than without; we identified factors associated with these events. Endoscopists should discuss these risks with patients before endoscopic eradication therapy.

Section snippets

Study Selection

We followed the Preferred Reporting Items for Systemic Reviews and Meta-Analysis guidelines for this study.8 A study was included in our analysis if it (1) was a clinical trial, prospective study, or retrospective study; (2) was published in a peer-reviewed journal or a meeting abstract (2012–2014); (3) had patients with BE, with or without dysplasia, who were treated with RFA with or without EMR; and (4) monitored and reported adverse events. A study was excluded if (1) the rate of adverse

Results

Our search resulted in 1521 citations between 1980 and 2014. Of those, 37 studies (28 published manuscripts and 9 meeting abstracts) met the inclusion criteria, totaling 9200 patients.5, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30, 31, 32, 33, 34, 35, 36, 37, 38, 39, 40, 41, 42, 43, 44 These included 16 prospective studies/clinical trials (totaling 791 patients) and 21 retrospective studies (totaling 8409 patients). Further details on study selection

Clinical Implications

As the incidence of EAC continues to increase, clinicians need to identify and treat potential risk factors of this deadly disease. BE is one of the major risk factors for EAC. Endoscopic therapy, RFA with or without EMR, to treat BE-related dysplasia has increased dramatically during the past decade. With the spreading use of RFA, clinicians need better understanding of the potential adverse events involved with this treatment method. In this meta-analysis, we showed that the overall risk of

Conclusions

The results of this systematic review and meta-analysis provide estimates of the rate of overall and individual adverse events related to RFA with and without EMR; stricture formation was the most common adverse event. The rate of severe adverse events (perforation) is very low. The use of EMR to remove nodules or lesions, although essential, appears to significantly increase the risk of adverse events. It is critical to discuss these issues with patients before embarking on such treatment

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    Conflicts of interest These authors disclose the following: Dr Wolfsen receives research funding from Olympus and Ninepoint Medical. Dr Sharma receives research funding from Olympus, Cook, and Takeda. Dr Wani has received educational grants from Covidien, Cook, and Boston Scientific and is a consultant for Covidien. The remaining authors disclose no conflicts.

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