Only 80% Eradication Rates of Barrett’s Esophagus With Long-Term Follow-Up of Endoscopic Therapy Studies

Patients with high-grade dysplasia and/or early cancer in Barrett’s esophagus (BE) are treated with endoscopic therapy (BET), with the goal of complete eradication of all intestinal metaplasia (CE-IM) and neoplasia (CE-N). BET is a set of endoscopic techniques, including endoscopic mucosal resection, usually followed by mucosal ablative procedures, such as radiofrequency ablation, cryotherapy, or argon plasma coagulation. Although immediate post-BET results have shown to be excellent, it is unclear how durable the effect of BET is in long-term follow-up. This systematic review and meta-analysis evaluated the long-term efficacy of BET using stringent criteria to include studies that followed patients with BE for a minimum of 2 years after achieving confirmed CE-IM or CE-N, as well as studies with clearly defined surveillance intervals and systematic sampling protocols. 

A total of 8 studies met criteria and included 794 patients who underwent BET, of whom 658 completed therapy and 598 completed follow-up. The pooled estimate of patients achieving CE-N was 95.9% (91.8%-94.9%; I2=95.9%), with an intent-to-treat pooled estimate of 84.5% (69.8%-94.9%; I2=95.9%). The overall pooled estimate of CE-IM was 90.9% (83%-96.6%; I2=89.1%), with an intent-to-treat pooled estimate of 79.3% (64.3%-91.1%; I2=95.5%). Of the 598 patients followed for a mean duration of 3.4 years (range, 27-69.7 months), overall pooled rates of durable CE-N and CE-IM were 89% (73.4%-98.2%; I2=96%) and 77.8% (65.6%-88%; I2=90.9%), with intent-to-treat analysis showing 70% (49.5%-87%; I2=97.1%) and 62.9% (44.4%-79.7%; I2=96.4%) for CE-N and CE-IM, respectively. Only 2 studies provided data from beyond 5 years of follow-up, with rates of 54.3% (41.5%-67%) and 50% (41.5%-58.5%) for CE-N and CE-IM, respectively.