Document Detail


Systematic review and meta-analysis of endoscopic ablative treatment of Barrett's esophagus.
MedLine Citation:
PMID:  25293990     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
Background: Barrett's esophagus (BE) is the main risk factor for esophageal adenocarcinoma. Its therapeutic approach is controversial and surgical treatment in the presence of high-grade intraepithelial neoplasia may be indicated. Endoscopic approach is an alternative with lower mortality and morbidity rates and favorable results. Objective: To define the best option, according to literature, to treat Barrett's Esophagus. Materials and methods: Design: Systematic review of PUBMED, EMBASE, LILACS, and Cochrane Library databases was conducted and articles of randomized, controlled studies on BE endoscopic ablative treatment were selected. The systematic review through PUBMED retrieved results with higher evidence level and available recommendation grade regarding BE ablative therapy. Nine articles on randomized, controlled studies classified as A or B according to the Oxford table were selected. Cryotherapy, laser, photodynamic therapy (PDT), multipolar electrocoagulation (MPEC), and ablation through argon plasma coagulation (APC) and radiofrequency were considered ablation therapies. Patients: 649 patients from 10 different studies were analysed. Results: PDT was found to present an increase in treatment failure compared with APC, NNH = -7. BE ablation through MPEC or APC was found to have similar risk for treatment failure in meta-analysis. PDT associated with proton pump inhibitor (PPI) is beneficial for BE ablation regarding PPI use alone, NNT = 2.Radiofrequency with PPI is an efficient method to reduce risk of treatment failure, NNT = 1. Conclusions: There are no studies demonstrating the benefit of indicating cryotherapy or laser therapy for BE endoscopic approach. APC ablation was found to have superior efficacy compared with PDT and ablation through APC and MPEC was found to present effective, similar results. Radiofrequency is the most recent approach requiring comparative studies for indication.
Authors:
Thiago Ferreira Souza; Everson Luiz Almeida Artifon; Luis Henrique Mazzonetto Mestieri; Sílvia Mansur Reimão; Felipe Toyama Aires; Wanderley Marques Bernardo; Jose Pinhata Otoch; Eduardo Guimarães Hourneaux Moura
Publication Detail:
Type:  JOURNAL ARTICLE    
Journal Detail:
Title:  Revista de gastroenterologia del Peru : organo oficial de la Sociedad de Gastroenterologia del Peru     Volume:  34     ISSN:  1609-722X     ISO Abbreviation:  Rev Gastroenterol Peru     Publication Date:    2014 July-September
Date Detail:
Created Date:  2014-10-8     Completed Date:  -     Revised Date:  2014-10-9    
Medline Journal Info:
Nlm Unique ID:  9108294     Medline TA:  Rev Gastroenterol Peru     Country:  -    
Other Details:
Languages:  ENG     Pagination:  217-224     Citation Subset:  -    
Vernacular Title:
Revisión sistemática y meta-análisis del tratamiento ablativo endoscópico del esófago de Barrett.
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