Complete endoscopic resection may not be suitable as sole therapy for Barrett’s oesophagus
Complete endoscopic resection (CER) of Barrett’s oesophagus (BE) results in a complete eradication rate of 85 percent, with nearly 6-percent recurrent rate of neoplasia, reports a recent study. Additionally, the estimated rate of postprocedural stricture was 37.4 percent.
A total of eight studies involving 676 patients (high-grade dysplasia, 54 percent) met the inclusion criteria.
The pooled estimated rates were 85.0 percent (95 percent CI, 79.4‒89.2 percent) for complete eradication of intestinal metaplasia and 96.6 percent (94.0‒98.1 percent) for complete eradication of intestinal neoplasia. Recurrence rates of intestinal metaplasia and neoplasia were 15.7 percent (8.0‒28.4 percent) and 5.8 percent (3.9‒8.6 percent), respectively.
Estimated incidences of adverse events were as follows: stricture (37.4 percent; 24.4‒52.6 percent), bleeding (7.9 percent; 4.4‒13.8 percent) and perforation (2.3 percent; 1.3‒4.1 percent).
“On the basis of this high rate of adverse events and significant heterogeneity in the studies included, the present meta-analysis cannot endorse CER as sole therapy for BE,” the investigators said.
To report the rate of eradication and recurrence of both neoplasia and intestinal mucosa, as well as the rate of adverse events for CER of BE, the investigators conducted a systematic review and meta-analysis of cohort studies that reported the clinical outcome of patients with BE who underwent CER and had at least 15-month follow-up after the time of elimination of BE.
Main outcomes included pooled estimated rates of complete eradication of intestinal metaplasia and neoplasia, recurrence of intestinal metaplasia and neoplasia, and incidence of oesophageal stricture, bleeding and perforation.