Background: The mainstay approach in endoscopic eradication therapy (EET) for dysplastic Barrett’s esophagus (BE) includes the endoscopic resection of visible lesions, accompanied by ablation of the residual metaplastic epithelium. Cryoablation therapy is one such emerging ablation technique in this field. This systematic review with a meta-analysis aims to accumulate pooled data on cryoablation performance in the treatment of patients with BE and to compare this technique to the standard of care radiofrequency ablation (RFA). Methods: The MEDLINE, Cochrane, and Scopus databases were searched until June 2024 for studies evaluating BE management using cryoablation for cumulative results. The primary outcome was the complete eradication of dysplasia (CED) and intestinal metaplasia (CEIM) in BE compared to RFA, while secondary outcomes included the respective pooled rates using cryoablation, recurrence, and adverse events, with a separate analysis for strictures. The meta-analyses were based on a random-effects model, and the results were reported as odds ratios (ORs) with 95% confidence intervals (CIs). Subgroup analyses by type of cryoablation were also performed. Results: Twenty-three studies (1604 patients) were finally included, four of which were comparative. CED and CEIM did not differ significantly between cryoablation and RFA [OR= 0.95 (95%CI: 0.50–1.81) and OR = 0.57 (95%CI: 0.20–1.63), respectively)]. The pooled rates of CED, CEIM, and recurrence after cryoablation were 84.2% (95%CI: 79.1–89.3), 64.1% (95%CI: 49.2–79.0), and 8.3% (95%CI: 4.7–11.9), accompanied by high rates of heterogeneity. Adverse events were noted in 14.5% (95%CI: 9.9–19.2) of cases, and 6.5% (95%CI: 4.1–9.0) developed strictures. In the subgroup analysis, the cryoballoon achieved a reduction in heterogeneity in CED, adverse events, and stricture formation, whereas spray catheters provided homogenous results in terms of recurrence. Conclusions: Cryoablation provides equal outcomes compared to RFA in the treatment of patients with BE, with the cryoballoon achieving relatively homogenous rates of CED and adverse events.
背景：内镜下根除治疗（EET）是处理异型增生性巴雷特食管（BE）的主要方法，包括内镜下切除可见病灶，并对残余的化生上皮进行消融。冷冻消融是该领域新兴的消融技术之一。本系统综述与荟萃分析旨在汇总冷冻消融治疗BE患者疗效的合并数据，并将该技术与标准治疗射频消融（RFA）进行比较。方法：检索截至2024年6月的MEDLINE、Cochrane和Scopus数据库，纳入评估冷冻消融治疗BE疗效的研究以进行结果汇总。主要结局指标是与RFA相比，冷冻消融实现BE异型增生完全消除（CED）和肠上皮化生完全消除（CEIM）的情况；次要结局指标包括冷冻消融各自的合并率、复发率和不良事件，并对狭窄进行了单独分析。荟萃分析采用随机效应模型，结果以比值比（OR）及95%置信区间（CI）报告。同时按冷冻消融类型进行了亚组分析。结果：最终纳入23项研究（1604例患者），其中4项为比较性研究。冷冻消融与RFA在CED和CEIM方面无显著差异[OR分别为0.95（95%CI：0.50–1.81）和0.57（95%CI：0.20–1.63）]。冷冻消融后CED、CEIM和复发的合并率分别为84.2%（95%CI：79.1–89.3）、64.1%（95%CI：49.2–79.0）和8.3%（95%CI：4.7–11.9），异质性较高。不良事件发生率为14.5%（95%CI：9.9–19.2），狭窄发生率为6.5%（95%CI：4.1–9.0）。亚组分析显示，冷冻球囊在CED、不良事件和狭窄形成方面降低了异质性，而喷雾导管在复发率方面提供了同质性结果。结论：在BE患者的治疗中，冷冻消融与RFA疗效相当，其中冷冻球囊在CED和不良事件方面获得了相对同质性的结果。
肿瘤(癌症)患者之家