Systematic review and meta-analysis of endoscopic ablative treatment of Barrett's esophagus.

[esophageal adenocarcinoma]

Background : Barrett 's esophagus (BE ) is the main risk factor for esophageal adenocarcinoma . Its therapeutic approach is controversial and surgical treatment in the presence of high -grade intraepithelial neoplasia may be indicated . Endoscopic approach is an alternative with lower mortality and morbidity rates and favorable results . Objective : To define the best option , according to literature , to treat Barrett 's Esophagus . Materials and methods : Design : Systematic review of PUBMED , EMBASE , LILACS , and Cochrane Library databases was conducted and articles of randomized , controlled studies on BE endoscopic ablative treatment were selected . The systematic review through PUBMED retrieved results with higher evidence level and available recommendation grade regarding BE ablative therapy . Nine articles on randomized , controlled studies classified as A or B according to the Oxford table were selected . Cryotherapy , laser , photodynamic therapy (PDT ), multipolar electrocoagulation (MPEC ), and ablation through argon plasma coagulation (APC ) and radiofrequency were considered ablation therapies . Patients : 649 patients from 10 different studies were analysed . Results : PDT was found to present an increase in treatment failure compared with APC , NNH = -7 . BE ablation through MPEC or APC was found to have similar risk for treatment failure in meta -analysis . PDT associated with proton pump inhibitor (PPI ) is beneficial for BE ablation regarding PPI use alone , NNT = 2 .Radiofrequency with PPI is an efficient method to reduce risk of treatment failure , NNT = 1 . Conclusions : There are no studies demonstrating the benefit of indicating cryotherapy or laser therapy for BE endoscopic approach . APC ablation was found to have superior efficacy compared with PDT and ablation through APC and MPEC was found to present effective , similar results . Radiofrequency is the most recent approach requiring comparative studies for indication .

Diseases
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Diseases presenting "cryotherapy or laser therapy for be endoscopic approach" symptom

esophageal adenocarcinoma

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