title: Esophageal adenocarcinoma in Barrett's esophagus after endoscopic ablative therapy: a meta-analysis and systematic review.
abstract: OBJECTIVE
  The extent of reduction of esophageal adenocarcinoma (EAC) incidence in Barrett's esophagus (BE) patients after endoscopic ablation is not known. The objective of this study was to determine the cancer incidence in BE patients after ablative therapy and compare these rates to cohort studies of BE patients not undergoing ablation.
  
  
  METHODS
  A MEDLINE search of the literature on the natural history and ablative modalities in BE patients was performed. Patients with nondysplastic BE (NDBE), low-grade dysplasia (LGD), or high-grade dysplasia (HGD) and follow-up of at least 6 months were included. The rate of cancer in patients undergoing ablation and from the natural history data was calculated using weighted-average incidence rates (WIR).
  
  
  RESULTS
  A total of 53 articles met the inclusion criteria for the natural history data. Pooled natural history data showed cancer incidence of 5.98/1,000 patient-years (95% CI 5.05-6.91) in NDBE; 16.98/1,000 patient-years (95% CI 13.1-20.85) in LGD; and 65.8/1,000 patient-years (95% CI 49.7-81.8) in HGD patients. A total of 65 articles met the inclusion criteria for BE patients undergoing ablation (1,457 patients, NDBE; 239 patients, LGD; and 611 patients, HGD). The WIR for cancer was 1.63/1,000 patient-years (95% CI 0.07-3.34) for NDBE; 1.58/1,000 patient-years (95% CI 0.66-3.84) for LGD; and 16.76/1,000 patient-years (95% CI 10.6-22.9) for HGD patients.
  
  
  CONCLUSIONS
  Compared to historical reports of the natural history of BE, ablation may be associated with a reduction in cancer incidence, although such a comparison is limited by likely heterogeneity between treatment and natural history studies. The greatest benefit of ablation was observed in BE patients with HGD.
authors.affiliation: Division of Gastroenterology and Hepatology, Veterans Affairs Medical Center, University of Kansas School of Medicine, Kansas City, Missouri, USA.
authors.forename: Sachin
authors.initials: S
authors.lastname: Wani
authors.forename: Srinivas R
authors.initials: SR
authors.lastname: Puli
authors.forename: Nicholas J
authors.initials: NJ
authors.lastname: Shaheen
authors.forename: Brenda
authors.initials: B
authors.lastname: Westhoff
authors.forename: Sanjeev
authors.initials: S
authors.lastname: Slehria
authors.forename: Ajay
authors.initials: A
authors.lastname: Bansal
authors.forename: Amit
authors.initials: A
authors.lastname: Rastogi
authors.forename: Hari
authors.initials: H
authors.lastname: Sayana
authors.forename: Prateek
authors.initials: P
authors.lastname: Sharma
mesh_terms: D055011:Ablation Techniques; D000230:Adenocarcinoma / Q000453:epidemiology* / Q000473:pathology; D001471:Barrett Esophagus / Q000473:pathology / Q000628:therapy*; D004724:Endoscopy; D004938:Esophageal Neoplasms / Q000453:epidemiology* / Q000473:pathology; D006801:Humans; D015994:Incidence