Westerveld Donevan R, Nguyen Khaai, Banerjee Debdeep, Jacobs Chelsea, Kadle Nikhil, Draganov Peter V, Yang Dennis
Department of Internal Medicine, University of Florida College of Medicine, Gainesville, Florida, United States.
Khaai Nguyen, College of Agriculture and Life Sciences, University of Florida, Gainesville, Florida, United States.
Endosc Int Open. 2020 Feb;8(2):E172-E178. doi: 10.1055/a-1067-4520. Epub 2020 Jan 22.
Balloon cryoablation (BC) is a novel procedure for endoscopic ablation of Barrett's esophagus (BE- associated neoplasia. We performed a meta-analysis to assess the feasibility, effectiveness, and safety of BC for treatment of BE neoplasia. Several databases were searched for relevant articles (PubMed, Web of Science, Google Scholar, EMBASE) as well as abstracts of recent gastroenterology meetings. Data extraction was performed by two investigators using standardized forms, including age, gender, length of BE segment, prior treatments, procedural time and number ablation sessions, technical feasibility, adverse events, and eradication rates of intestinal metaplasia (CE-IM) and dysplasia (CE-D) at follow-up. Quality of the studies was assessed using a modified Newcastle Ottawa Scale. Seven studies met inclusion criteria for a total of 548 ablation sessions in 272 patients. The most common histopathology reported prior to BC was high-grade dysplasia (n = 131), followed by low-grade dysplasia (n = 75), and intramucosal adenocarcinoma (n = 52). The pooled rate for technical feasibility was 95.8 % (95 % CI: 93.6-97.5 %; I = 13.2 %; = 0.3). Pooled rates of CE-IM and CE-D were 85.8 % (95 % CI: 77.8-92.2 %, I = 55.5 %; p = 0.04) and 93.8 % (95 % CI: 85.5-98.7 %, I = 74.2 %; = 0.001), respectively. The overall adverse event (AE) rate was 12.5 % (34 out of 272 patients), of which stricture formation was the most common (5.8 %), followed by mucosal laceration (0.7 %), perforation (0.4 %), and bleeding (0.4 %). All AEs were successfully managed endoscopically. This meta-analysis suggests that BC is a safe and effective ablative technique for treatment of BE neoplasia; future prospective comparative trials are needed to corroborate these initial findings.
球囊冷冻消融术（BC）是一种用于内镜下消融巴雷特食管（BE）相关肿瘤的新方法。我们进行了一项荟萃分析，以评估BC治疗BE肿瘤的可行性、有效性和安全性。检索了多个数据库（PubMed、科学网、谷歌学术、EMBASE）以及近期胃肠病学会议的摘要，以查找相关文章。由两名研究人员使用标准化表格进行数据提取，包括年龄、性别、BE段长度、既往治疗、手术时间和消融次数、技术可行性、不良事件以及随访时肠化生（CE-IM）和异型增生（CE-D）的根除率。使用改良的纽卡斯尔渥太华量表评估研究质量。七项研究符合纳入标准，共纳入272例患者，进行了548次消融手术。BC术前报告的最常见组织病理学类型为高级别异型增生（n = 131），其次是低级别异型增生（n = 75）和黏膜内腺癌（n = 52）。技术可行性的合并率为95.8%（95%CI：93.6 - 97.5%；I² = 13.2%；P = 0.3）。CE-IM和CE-D的合并率分别为85.8%（95%CI：77.8 - 92.2%，I² = 55.5%；P = 0.04）和93.8%（95%CI：85.5 - 98.7%，I² = 74.2%；P = 0.001）。总体不良事件（AE）发生率为12.5%（272例患者中有34例），其中狭窄形成最为常见（5.8%），其次是黏膜撕裂（0.7%）、穿孔（0.4%）和出血（0.4%）。所有不良事件均通过内镜成功处理。这项荟萃分析表明，BC是一种治疗BE肿瘤的安全有效的消融技术；未来需要进行前瞻性比较试验来证实这些初步发现。
