Division of Gastroenterology and Hepatology, Archbold Medical Group/Florida State University, Thomasville, Georgia.
Division of Gastroenterology and Hepatology, University of Colorado Anschutz Medical Campus, Aurora, Colorado.
Clin Gastroenterol Hepatol. 2016 Aug;14(8):1086-1095.e6. doi: 10.1016/j.cgh.2016.04.001. Epub 2016 Apr 9.
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.
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.
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.
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.
射频消融（RFA）联合或不联合内镜黏膜切除术（EMR）通常用于治疗伴有异型增生的 Barrett 食管。尽管该方法相对安全，但不良事件的发生率估计并不准确。我们进行了一项系统评价和荟萃分析，以评估 RFA 联合或不联合 EMR 相关不良事件的发生率。
我们检索了 MEDLINE、Embase、Web of Science 和 Cochrane Central 数据库，检索时间截至 2014 年 10 月 22 日。主要观察指标是 RFA 联合或不联合 EMR 后总的不良事件发生率。我们采用森林图比较研究间的效应大小。
在评估的 1521 篇文章中，有 37 篇符合纳入标准（共纳入 9200 例患者）。RFA 联合或不联合 EMR 的所有不良事件总发生率为 8.8%（95%置信区间 [CI]，6.5%-11.9%）；5.6%的患者发生狭窄（95% CI，4.2%-7.4%），1%发生出血（95% CI，0.8%-1.3%），0.6%发生穿孔（95% CI，0.4%-0.9%）。在比较 RFA 联合与不联合 EMR 的研究中，RFA 联合 EMR 的不良事件相对风险显著升高（4.4）（P=0.015）。与回顾性研究相比，前瞻性研究中不良事件的比例更高（11.3% vs. 7.8%，P=0.20）。其他与不良事件相关的因素包括 Barrett 食管、长度和基线组织学。
在一项系统评价和荟萃分析中，我们发现 RFA 联合 EMR 的不良事件相对风险约为不联合 EMR 的 4 倍；我们确定了与这些事件相关的因素。内镜医生应在进行内镜消除治疗前与患者讨论这些风险。
