Introduction The efficacy of complete Barrett's eradication by extensive endomucosal resection (E-EMR) of Barrett's oesophagus with early cancer ranges from 60% to 100% with a post-resection stricture rate of up to 88% in a recent RCT.1 The primary aim of this meta-analysis was to determine the long-term efficacy and safety of E-EMR for complete Barrett's eradication in patients with early Barrett's cancer.
Methods MEDLINE, EMBASE and PubMed databases were searched using keywords, “Barrett's oesophagus,” “oesophageal cancer,” “endomucosal resection,” “circumferential endomucosal resection,” Barrett's high-grade dysplasia and Barrett's intra-mucosal carcinoma from January 1965 to December 2011. Articles were selected/reviewed and data collected based on pre-defined inclusion criteria, independently by two authors (RK and TT). Meta-analysis using random effects model was done.
Results Thirteen studies (N=691) were included in the final analysis. (586 males, average age, 65.9 range 65–67). 116 patients in six studies had long-segment Barrett's. The average Barrett's length was 3.78 cm (range 2–4.9 cm). Visible lesions were seen in 371/586 (63.3%) patients. At an average of 2 (range 1.5–2.5) EMR sessions, four resections (range 3–8) were done per session Complete Barrett's eradication was achieved in 71.9% (95% CI 68.1% to 75.4%) and eradication of early Barrett's cancer in 96% (95% CI 91% to 99%) of patients. At an average follow-up of 20.5 months (range 9–31.6) Barrett's/dysplasia recurrence was seen in 13% (95% CI 10.7%>15.9%). Total number of resections (p=0.026) and age (p=0.037) were significant confounders for complete Barrett's eradication. The overall stricture rate was 39% (95% CI 35%>43%). Procedure related perforations occurred in 12/691 (1.3%) and bleeding in 9.9% (95% CI 5.1%>13.5%) of patients. On meta-regression analysis there were no significant confounders for stricture formation.
Conclusion Complete long-term complete Barrett's eradication in patients harbouring early cancer is effective in only 71.9% of patients with age and total endoscopic resections being significant confounders. The procedure appears safe but has a stricture rate of 39%.
Competing interests R Krishnamoorthy: None declared, K Abrams: None declared, K Ragunath Conflict with: Member of the shortlisting panel for the Endoscopy section of the BSG., T Thomas: None declared.
Reference 1. van Vilsteren FG, Pouw, ER, Seewald S, et al. Stepwise radical endoscopic rsection versus radiofrequency ablation for Barrett's oesophagus with high-grade dysplasia or early cancer: a multicentre randomised trial. Gut 2011;60:765–73.
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