Clin Endosc.  2024 Mar;57(2):181-190. 10.5946/ce.2023.065.

Cryotherapy versus radiofrequency ablation in the treatment of dysplastic Barrett’s esophagus with or without early esophageal neoplasia: a systematic review and meta-analysis

• Gomes ILC
• de Moura DTH
• Ribeiro IB
• Marques SB
• de Sousa Carlos A
• Nunes BCM
• Hirsch BS
• de Oliveira GHP
• Trasolini RP
• Bernardo WM
• de Moura EGH

• KMID: 2553753
• DOI: http://doi.org/10.5946/ce.2023.065

Abstract

Background/Aims
Radiofrequency ablation (RFA) is the first-line therapy for dysplastic Barrett’s esophagus (BE). Therefore, cryotherapy has emerged as an alternative treatment option. This study aimed to compare the efficacies of these two techniques based on the rates of complete eradication of intestinal metaplasia (CE-IM) and dysplasia (CE-D). Adverse events and recurrence have also been reported.
Methods
An electronic search was conducted using the Medline (PubMed), Embase, LILACS, and Google Scholar databases until December 2022. Studies were included comparing cryotherapy and RFA for treating dysplastic BE with or without early esophageal neoplasia. This study was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.
Results
Three retrospective cohort studies involving 627 patients were included. Of these, 399 patients underwent RFA, and 228 were treated with cryotherapy. There was no difference in CE-IM (risk difference [RD], –0.03; 95% confidence interval [CI], –0.25 to 0.19; p=0.78; I2=86%) as well as in CE-D (RD, –0.03; 95% CI, –0.15 to 0.09; p=0.64; I2=70%) between the groups. The absolute number of adverse events was low, and there was no difference in the recurrence rate.
Conclusions
Cryotherapy and RFA were equally effective in treating dysplastic BE, with or without early esophageal neoplasia.

Keyword

Barrett esophagus; Cryotherapy; Radiofrequency ablation

Figure

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  Fig. 1. Study selection flowchart according to Preferred Reporting Items for Systematic Reviews and Meta-analyses.

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  Fig. 2. Risk of bias by ROBINS I.

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  Fig. 3. Rate of complete eradication of intestinal metaplasia. M-H, Mantel-Haenszel test; CI, confidence interval; I2, heterogeneity.

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  Fig. 4. Rate of complete eradication of dysplasia. M-H, Mantel-Haenszel test; CI, confidence interval; I2, heterogeneity.

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  Fig. 5. Recurrence. M-H, Mantel-Haenszel test; CI, confidence interval; I2, heterogeneity.

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