title: Adverse Events After Radiofrequency Ablation in Patients With Barrett's Esophagus: A Systematic Review and Meta-analysis.
abstract: Radiofrequency ablation (RFA) with or without endoscopic mucosal resection (EMR) is routinely used for treatment of Barrett's esophagus with dysplasia. Despite the relative safety of this method, there have been imprecise estimates of the rate of adverse events. We performed a systematic review and meta-analysis to assess the rate of adverse events associated with RFA with and without EMR.
  
  
  
  We searched MEDLINE, Embase, Web of Science, and Cochrane Central through October 22, 2014. The primary outcome of interest was the overall rate of adverse events after RFA with or without EMR. We used forest plots to contrast effect sizes among studies.
  
  
  
  Of 1521 articles assessed, 37 met our inclusion criteria (comprising 9200 patients). The pooled rate of all adverse events from RFA with or without EMR was 8.8% (95% confidence interval [CI], 6.5%-11.9%); 5.6% of patients developed strictures (95% CI, 4.2%-7.4%), 1% had bleeding (95% CI, 0.8%-1.3%), and 0.6% developed a perforation (95% CI, 0.4%-0.9%). In studies that compared RFA with vs without EMR, the relative risk for adverse events was significantly higher for RFA with EMR (4.4) (P = .015). There was a trend toward higher proportions of adverse events in prospective studies compared with retrospective studies (11.3% vs 7.8%, P = .20). Other factors associated with adverse events included Barrett's esophagus and length and baseline histology.
  
  
  
  In a systematic review and meta-analysis, we found the relative risk for adverse events from RFA to be about 4-fold higher with EMR than without; we identified factors associated with these events. Endoscopists should discuss these risks with patients before endoscopic eradication therapy.
authors.affiliation: Division of Gastroenterology and Hepatology, Archbold Medical Group/Florida State University, Thomasville, Georgia. Electronic address: bqumseya@archbold.org.
authors.forename: Bashar J
authors.initials: BJ
authors.lastname: Qumseya
authors.affiliation: Division of Gastroenterology and Hepatology, University of Colorado Anschutz Medical Campus, Aurora, Colorado.
authors.forename: Sachin
authors.initials: S
authors.lastname: Wani
authors.affiliation: Division of Gastroenterology and Hepatology, Veterans Affairs Medical Center and University of Kansas School of Medicine, Kansas City, Kansas.
authors.forename: Madhav
authors.initials: M
authors.lastname: Desai
authors.affiliation: Department of Biostatistics, Florida State University, Tallahassee, Florida.
authors.forename: Amira
authors.initials: A
authors.lastname: Qumseya
authors.affiliation: Harvard School of Public Health, Boston, Massachusetts.
authors.forename: Paul
authors.initials: P
authors.lastname: Bain
authors.affiliation: Division of Gastroenterology and Hepatology, Veterans Affairs Medical Center and University of Kansas School of Medicine, Kansas City, Kansas.
authors.forename: Prateek
authors.initials: P
authors.lastname: Sharma
authors.affiliation: Division of Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, Florida.
authors.forename: Herbert
authors.initials: H
authors.lastname: Wolfsen
mesh_terms: D001471:Barrett Esophagus / Q000628:therapy*; D017115:Catheter Ablation / Q000009:adverse effects*; D006801:Humans; D015994:Incidence
keywords: BE; Complication; Endoscopy; Esophageal; Risk Factor