Recurrence of intestinal metaplasia and early neoplasia after endoscopic eradication therapy for Barrett's esophagus: a systematic review and meta-analysis.

Autor:	Fujii-Lau LL; Washington University School of Medicine, St. Louis, MO, USA., Cinnor B; University of Colorado Anschutz Medical Campus, Aurora, CO, USA., Shaheen N; University of North Carolina, Chapel Hill, NC, USA., Gaddam S; Washington University School of Medicine, St. Louis, MO, USA., Komanduri S; Feinberg School of Medicine Northwestern University, Chicago, IL, USA., Muthusamy VR; University of California, Los Angeles, Los Angeles, CA, USA., Das A; Arizona Center for Digestive Health, Gilbert, AZ, USA., Wilson R; University of Colorado Anschutz Medical Campus, Aurora, CO, USA., Simon VC; University of Colorado Anschutz Medical Campus, Aurora, CO, USA., Kushnir V; Washington University School of Medicine, St. Louis, MO, USA., Mullady D; Washington University School of Medicine, St. Louis, MO, USA., Edmundowicz SA; University of Colorado Anschutz Medical Campus, Aurora, CO, USA., Early DS; Washington University School of Medicine, St. Louis, MO, USA., Wani S; University of Colorado Anschutz Medical Campus, Aurora, CO, USA.
Jazyk:	angličtina
Zdroj:	Endoscopy international open [Endosc Int Open] 2017 Jun; Vol. 5 (6), pp. E430-E449. Date of Electronic Publication: 2017 May 31.
DOI:	10.1055/s-0043-106578
Abstrakt:	Background: Conflicting data exist with regard to recurrence rates of intestinal metaplasia (IM) and dysplasia after achieving complete eradication of intestinal metaplasia (CE-IM) in Barrett's esophagus (BE) patients. Aim: (i) To determine the incidence of recurrent IM and dysplasia achieving CE-IM and (ii) to compare recurrence rates between treatment modalities [radiofrequency ablation (RFA) with or without endoscopic mucosal resection (EMR) vs stepwise complete EMR (SRER)]. Methods: A systematic search was performed for studies reporting on outcomes and estimates of recurrence rates after achieving CE-IM. Pooled incidence [per 100-patient-years (PY)] and risk ratios with 95 %CI were obtained. Heterogeneity was measured using the I ² statistic. Subgroup analyses, decided a priori, were performed to explore heterogeneity in results. Results: A total of 39 studies were identified (25-RFA, 13-SRER, and 2 combined). The pooled incidence of any recurrence was 7.5 (95 %CI 6.1 - 9.0)/100 PY with a pooled incidence of IM recurrence rate of 4.8 (95 %CI 3.8 - 5.9)/100 PY, and dysplasia recurrence rate of 2.0 (95 %CI 1.5 - 2.5)/100 PY. Compared to the SRER group, the RFA group had significantly higher overall [8.6 (6.7 - 10.5)/100 PY vs. 5.1 (3.1 - 7)/100 PY, P = 0.01] and IM recurrence rates [5.8 (4.3 - 7.3)/100 PY vs. 3.1 (1.7 - 4)/100 PY, P < 0.01] with no difference in recurrence rates of dysplasia. Significant heterogeneity between studies was identified. The majority of recurrences were amenable to repeat endoscopic eradication therapy (EET). Conclusion: The results of this study demonstrate that the incidence rates of overall, IM, and dysplasia recurrence rates post-EET are not inconsiderable and reinforce the importance of close surveillance after achieving CE-IM.
Databáze:	MEDLINE
Externí odkaz:	Zobrazit plný text záznamu