Meta-Analysis for Comparison between Antireflux Surgery with or without Endoscopic Management of Barrett’s Esophagus

Abstract

I n patients with BE, anti-reflux surgery aims to sustainable control reflux symptoms and heal reflux induced esophageal mucosal inflammation and prevent progression of BE to adenocarcinoma. Endoscopic resection of visible lesions if any, followed by ablation of the rest of the BE epithelium is the current standard of care for management of BE with confirmed dysplasia. Although the current literature describes multiple endoscopic and anti-reflux techniques for the management of BE, there is no published evidence on the efficacy of anti-reflux surgery followed by endoscopic management on the outcomes of BE. The objective of this study was to compare between anti-reflux surgery with or without endoscopic management of BE. In the present study, we searched Medline via PubMed, SCOPUS, Web of Science, Cochrane Central Register of Controlled Trials (CENTRAL), and Google Scholar. The search retrieved 2089 unique records. We then retained 57 potentially eligible records for full-texts screening. Finally, 6 studies were included. In the present systematic review and meta-analysis, we observed that the majority of the patients were males and aged more than 60 years old. We found that the prevalence of hiatal hernia among BE cases ranged from 60-98%. In the present systematic review and meta-analysis, four studied used RFA alone and two studies used RFA plus EMR. Five studies reported the rates of complete eradication of intestinal metaplasia. The overall effect estimates showed the rate of complete eradication of intestinal metaplasia was 65.5% (95% CI 47– 84%). Regarding the rate of complete eradication of dysplasia in the present study, we found that five studies reported the rates of complete eradication of dysplasia. The overall effect estimates showed the rate of complete eradication of dysplasia was 69.7% (95% CI 54.4– 85%).