title: Disease Progression in Barrett's Low-Grade Dysplasia With Radiofrequency Ablation Compared With Surveillance: Systematic Review and Meta-Analysis.
abstract: OBJECTIVE
  Barrett's esophagus (BE) is the only identifiable premalignant condition for esophageal adenocarcinoma (EAC). Management of BE with low-grade dysplasia continues to be controversial. We aimed to conduct a systematic review and meta-analysis comparing the risk of progression to high-grade dysplasia or EAC among patients with BE with low-grade dysplasia treated with radiofrequency ablation (RFA) compared with surveillance endoscopy.
  
  
  METHODS
  Our search included Medline, Embase, and Cochrane Central, was limited to English language articles, and was last searched on 31 December 2015. Studies were reviewed by title and abstract, and then full text by two independent reviewers. Two independent reviewers extracted data. Differences were resolved by consensus. The primary outcome of interest was the relative risk of disease progression among patients with BE with low-grade dysplasia treated with RFAcompared with surveillance.
  
  
  RESULTS
  Our search resulted in 2,029 citations, 19 studies were included in the final analysis, totaling 2,746 patients. Relative risk of disease progression in RFA compared with surveillance was 0.14% (95% confidence interval: 0.04-0.45), P=0.001. This measure was stable when only all studies were included. Absolute risk reduction was 10.9% and the number needed to treat was 9.2. Results were stable over several quality measures, overtime, and when excluding randomized trials. The cumulative rate of progression to high-grade dysplasia/EAC was lower in RFA compared with surveillance (1.7% vs. 12.6%, P<0.001).
  
  
  CONCLUSIONS
  Similarly, the incidence rate of progression among patients with surveillance was significantly higher from those treated with RFA (0.022 vs. 0.005, P<0.001). RFA results in a significant reduction risk of disease progression to high-grade dysplasia/EAC among patients with BE with low-grade dysplasia.
authors.affiliation: Division of Gastroenterology and Hepatology, Archbold Medical Group/Florida State University, Thomasville, Georgia, USA.
authors.forename: Bashar J
authors.initials: BJ
authors.lastname: Qumseya
authors.affiliation: Division of Gastroenterology and Hepatology, University of Colorado, Aurora, Colorado, USA.
authors.forename: Sachin
authors.initials: S
authors.lastname: Wani
authors.affiliation: Florida A &M University, Tallahassee, Florida, USA.
authors.forename: Sherif
authors.initials: S
authors.lastname: Gendy
authors.affiliation: Division of Gastroenterology and Hepatology, University of Colorado, Aurora, Colorado, USA.
authors.forename: Ben
authors.initials: B
authors.lastname: Harnke
authors.affiliation: Department of Gastroenterology and Hepatology, Academic Medical Centre Amsterdam, Amsterdam, Netherlands.
authors.forename: Jacques J
authors.initials: JJ
authors.lastname: Bergman
authors.affiliation: Division of Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, Florida, USA.
authors.forename: Herbert
authors.initials: H
authors.lastname: Wolfsen
mesh_terms: D000230:Adenocarcinoma / Q000175:diagnosis / Q000517:prevention & control*; D001471:Barrett Esophagus / Q000473:pathology* / Q000601:surgery*; D017115:Catheter Ablation; D018450:Disease Progression; D004938:Esophageal Neoplasms / Q000175:diagnosis / Q000517:prevention & control*; D004945:Esophagoscopy; D006801:Humans; D011159:Population Surveillance; D018570:Risk Assessment