Spatial distribution of dysplasia in Barrett’s esophagus segments before and after endoscopic ablation therapy: a meta-analysis

Abstract

Background: Dysplasia in Barrett’s esophagus is focal and difficult to locate. The aim of this meta-analysis was to understand the spatial distribution of dysplasia in Barrett’s esophagus before and after endoscopic ablation therapy. Methods: A systematic search was performed of multiple databases to July 2019. The location of dysplasia prior to ablation was determined using a clock face orientation (right or left half of the esophagus). The location of dysplasia post-ablation was classified as within the tubular esophagus or at the top of the gastric folds (TGF). Results: Thirteen studies with 2234 patients were identified. Pooled analysis from 6 studies (819 lesions in 802 patients) showed that before ablation, dysplasia was more commonly located in the right half versus the left half (OR 4.3; 95% CI [2.33-7.93]; p<0.01). Pooled analysis from 7 studies showed that dysplasia after ablation recurred in 101/1432 (7.05%; 95% CI [5.7-8.4%]) patients. Recurrence of dysplasia was located more commonly at the TGF (n=68) as compared to the tubular esophagus (n=34) (OR 5.33; 95% CI [1.75-16.21]; p<0.01). Of the esophageal lesions, 90% (27/30) were visible whereas only 46% (23/50) of the recurrent dysplastic lesions at TGF were visible (p<0.01). Conclusion: Before ablation, dysplasia in Barrett’s esophagus is found more frequently in the right half of the esophagus versus the left. Post-ablation recurrence is more commonly found in the top of the gastric folds and is non-visible as compared to the tubular esophagus, which is mainly visible.

Cryotherapy versus radiofrequency ablation in the treatment of dysplastic Barrett’s esophagus with or without early esophageal neoplasia: a systematic review and meta-analysis

“… 1 It is considered a premalignant condition owing to the established risk of developing dysplasia. 2 Mucosa with dysplasia may progress to adenocarcinoma, a disease with an increasing incidence and low survival rates. 3 , 4 Endoscopic eradication therapy (EET) of dysplastic areas prevents disease progression.…”

Measuring Quality in Barrett’s Endoscopy

“…BE inspection time improves yield of dysplasia, with additional attention paid to areas harboring increased dysplasia such as the most proximal portions of intestinal metaplasia and the right hemisphere. 8,9 Second, recognition of subtle mucosal irregularities with targeted biopsies and training to optimize lesion recognition can significantly increase dysplasia detection. 10,11 Third, ensuring adequate biopsies throughout the BE segment by using the Seattle protocol yields more dysplasia compared with random biopsies; however, because adherence to biopsy protocol has been found to be inadequate, 12 computer-assisted or wide-field brush biopsy techniques have been developed but not regularly integrated into clinical practice.…”