A systematic review of the evidence for radiofrequency ablation for Barrett’s esophagus
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Radiofrequency ablation with the HALO system is a new option for the treatment of patients with Barrett’s esophagus. This systematic review summarizes the results of all relevant publications on this topic to answer patient-relevant clinical questions and to evaluate the potential benefit and harm of this new therapy.
A systematic literature search of MEDLINE and CENTRAL up to May 2009 was performed. To identify the relevant literature, references were evaluated by two reviewers independently. The inclusion criteria for the review required that studies investigated patients with Barrett’s esophagus, used radiofrequency ablation as the intervention, and had a minimum follow-up period of 12 months.
A total of nine relevant observational studies (involving 429 patients) were identified. Complete eradication of Barrett’s esophagus dysplasia and metaplasia was achieved respectively for 71–100% and for 46–100% of the patients. Only six cases of stenosis and one case of buried intestinal metaplasia were reported among all the patients. Only a few mild adverse events were reported.
Based on the evidence of observational studies, the summary of the current data suggests that radiofrequency ablation with the HALO system could be a promising method associated with a low complication rate, low risk of stricture formations, and a minor probability of buried glands. To evaluate the potential benefit at a higher level of evidence, randomized controlled trials (RCTs) involving a direct comparison with other more established endoscopic methods such as photodynamic therapy are necessary.
KeywordsBarrett’s esophagus Radiofrequency ablation Systematic review
We thank Ursula Püringer and Eva Matyas for their assistance in reviewing and collecting the data and Eugenie Lamont for helping to prepare the manuscript.
This review was for the most part commissioned by and conducted in collaboration with the Elisabethinen Hospital Linz. Thomas Semlitsch, Klaus Jeitler, Karl Horvath, Nicole Pignitter from the Evidence Based Medicine Review Center of the Medical University of Graz and Andrea Siebenhofer from the Goethe University, Frankfurt am Main were paid by the Elisabethinen Hospital Linz. Rainer Schoefl and Franz Harnoncourt are employees of the Elisabethinen Hospital Linz. Thomas Semlitsch, Klaus Jeitler, Karl Horvath, Nicole Pignitter, Andrea Siebenhofer, Rainer Schoefl, and Franz Harnoncourt have no conflicts of interest or financial ties to disclose.
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