465. COMPLETE RESPONSE IN BARRETT’S HIGH-GRADE DYSPLASIA WITH THE UTILISATION OF RADIOFREQUENCY ABLATION: A SYSTEMATIC REVIEW

Abstract

Radiofrequency ablation (RFA) is increasingly utilised as part of the endoscopic treatment of Barrett’s esophagus (BE) with high-grade dysplasia as a recognised alternative to surgical resection. The aim of this review is to summarise the current evidence on the utility of RFA in achieving complete clearance of HGD within BE and any resultant treatment complications with this endoscopic therapeutic option. A search of the major reference databases (PubMed, Medline, Cochrane) was performed with no time limits up to December 2022. Results were screened in line with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Studies were included if the patient cohort included patients with HGD undergoing RFA, regardless of whether other endoscopic and/or surgical techniques were subsequently utilised and analysed. Fourteen studies comprising 1411 patients were included. Among this cohort, 850 patients with HGD underwent at least one session of RFA. Complete eradication of HGD was noted in 800/850 (94.1%) of patients. The pooled estimates of complete eradication of HGD and intestinal metaplasia (IM) were 92.5% (95% CI 87.6%–96.2%) and 81.8% (95% CI 74.9%–87.9%), respectively. The incidence of adverse events related to RFA was low, with esophageal stricture being the most common (10.6%). Long-term follow-up reported in the included studies showed sustained eradication of HGD with recurrence noted in 22 (2.6%) of patients. RFA is a safe and effective treatment option for patients with HGD within BE. However, data from larger patient cohorts, ideally within a trial setting, are needed, to establish the long-term treatment efficacy and identify cohorts that may not benefit from this procedure or require multiple treatments.