Center for Esophageal Diseases and Swallowing, Division of Gastroenterology and Hepatology, Department of Medicine, University of North Carolina, Chapel Hill, North Carolina.
Clin Gastroenterol Hepatol. 2013 Oct;11(10):1245-55. doi: 10.1016/j.cgh.2013.03.039. Epub 2013 May 2.
BACKGROUND & AIMS: In patients with Barrett's esophagus (BE), radiofrequency ablation (RFA) safely and effectively eradicates dysplasia and intestinal metaplasia. We aimed to determine the efficacy and durability of RFA for patients with dysplastic and nondysplastic BE.
We performed a systematic review and meta-analysis of studies identified in PubMed and EMBASE that reported the proportion of patients treated with RFA who had complete eradication of dysplasia (CE-D) and intestinal metaplasia (CE-IM), and the proportion of patients with recurrent IM after successful treatment. Pooled estimates of CE-D, CE-IM, IM recurrence, and adverse events were calculated.
We identified 18 studies of 3802 patients reporting efficacy and 6 studies of 540 patients reporting durability. Ten were prospective cohort studies, 9 were retrospective cohort studies, and 1 was a randomized trial. CE-IM was achieved in 78% of patients (95% confidence interval [CI], 70%-86%) and CE-D was achieved in 91% (95% CI, 87%-95%). After eradication, IM recurred in 13% (95% CI, 9%-18%). Progression to cancer occurred in 0.2% of patients during treatment and in 0.7% of those after CE-IM. Esophageal stricture was the most common adverse event and was reported in 5% of patients (95% CI, 3%-7%). Confidence in most summary estimates was limited by a high degree of heterogeneity, which did not appear to be caused by single outlier studies.
Treatment of BE with RFA results in CE-D and CE-IM in a high proportion of patients, with few recurrences of IM after treatment and a low rate of adverse events. Despite the large amount of study heterogeneity, these data provide additional information for patients and providers to make informed treatment decisions.
在 Barrett 食管（BE）患者中，射频消融（RFA）安全有效地根除了异型增生和肠化生。本研究旨在确定 RFA 对异型增生和非异型增生 BE 患者的疗效和持久性。
我们对在 PubMed 和 EMBASE 中检索到的报告 RFA 治疗后完全消除异型增生（CE-D）和肠化生（CE-IM）患者比例以及成功治疗后出现 IM 复发患者比例的研究进行了系统回顾和荟萃分析。计算了 CE-D、CE-IM、IM 复发和不良事件的汇总估计值。
我们共纳入了 18 项涉及 3802 例患者的疗效研究和 6 项涉及 540 例患者的持久性研究。其中 10 项为前瞻性队列研究，9 项为回顾性队列研究，1 项为随机试验。78%（95%置信区间[CI]，70%-86%）的患者实现了 CE-IM，91%（95% CI，87%-95%）的患者实现了 CE-D。在根除后，13%（95% CI，9%-18%）的患者出现 IM 复发。在治疗期间和 CE-IM 后，分别有 0.2%（95% CI，0.0%-0.6%）和 0.7%（95% CI，0.2%-1.5%）的患者进展为癌症。食管狭窄是最常见的不良事件，发生率为 5%（95% CI，3%-7%）。由于存在高度异质性，大多数汇总估计的可信度受到限制，但这种异质性似乎不是由单个异常研究引起的。
RFA 治疗 BE 可使大多数患者实现 CE-D 和 CE-IM，治疗后 IM 复发率低，不良事件发生率低。尽管研究存在很大的异质性，但这些数据为患者和提供者提供了更多信息，以做出明智的治疗决策。
