Endotherapy versus surgery for early neoplasia in Barrett's esophagus: a meta-analysis.
BACKGROUND
Esophagectomy is the conventional treatment for Barrett's esophagus with high-grade dysplasia and intramucosal cancer. Endotherapy is an alternative treatment.


OBJECTIVE
To compare the efficacy and safety of these 2 treatments.


METHODS
PubMed, Web of Science, EMBASE, Cochrane Library and momentous meeting abstracts were searched. Studies comparing endotherapy with esophagectomy were included in the meta-analysis. Pooling was conducted in a random-effects model.


METHODS
Tertiary-care facility.


METHODS
Seven studies involving 870 patients were included.


METHODS
Endotherapy and esophagectomy.


METHODS
Neoplasia remission rate, neoplasia recurrence rate, overall survival rate, neoplasia-related death, and major adverse events.


RESULTS
Meta-analysis showed that there was no significant difference between endotherapy and esophagectomy in the neoplasia remission rate (relative risk [RR] 0.96; 95% CI, 0.91-1.01); overall survival rate at 1 year (RR 0.99; 95% CI, 0.94-1.03), 3 years (RR 1.03; 95% CI, 0.96-1.10), and 5 years (RR 1.00; 95% CI, 0.93-1.06); and neoplasia-related mortality (risk difference [RD] 0; 95% CI, -0.02 to 0.01). Endotherapy was associated with a higher neoplasia recurrence rate (RR 9.50; 95% CI, 3.26-27.75) and fewer major adverse events (RR 0.38; 95% CI, 0.20-0.73).


CONCLUSIONS
Relatively small number of retrospective studies available, different types of endoscopic treatments were used.


CONCLUSIONS
Endotherapy and esophagectomy show similar efficacy except in the neoplasia recurrence rate, which is higher after endotherapy. Prospective, randomized, controlled trials are needed to confirm these results.
Department of Endoscopy, Eastern Hepatobiliary Hospital, The Second Military Medical University, Shanghai, China.
Jun
J
Wu
Department of Endoscopy, Eastern Hepatobiliary Hospital, The Second Military Medical University, Shanghai, China.
Ya-min
YM
Pan
Department of Endoscopy, Eastern Hepatobiliary Hospital, The Second Military Medical University, Shanghai, China.
Tian-tian
TT
Wang
Department of Endoscopy, Eastern Hepatobiliary Hospital, The Second Military Medical University, Shanghai, China.
Dao-jian
DJ
Gao
Department of Endoscopy, Eastern Hepatobiliary Hospital, The Second Military Medical University, Shanghai, China.
Bing
B
Hu
D001471:Barrett Esophagus / Q000150:complications / Q000473:pathology / Q000628:therapy; D017115:Catheter Ablation / Q000379:methods*; D004938:Esophageal Neoplasms / Q000209:etiology / Q000473:pathology / Q000628:therapy; D016629:Esophagectomy / Q000379:methods*; D004945:Esophagoscopy / Q000379:methods*; D006801:Humans; D009367:Neoplasm Staging; D010778:Photochemotherapy / Q000379:methods*
BE; Barrett’s esophagus; HGD; IMC; PDT; RFA; high-grade dysplasia; intramucosal cancer; photodynamic therapy; radiofrequency ablation