A systematic review and meta-analysis of the effectiveness and safety of radiofrequency ablation in Barrett esophagus

Background: Barrett’s esophagus (BE) is a precursor to esophageal adenocarcinoma, with low-grade dysplasia (LGD) and high-grade dysplasia (HGD) as key risk factors for progression. Radiofrequency ablation (RFA) is a minimally invasive treatment targeting dysplastic tissues in BE. This paper assesses RFA’s efficacy in preventing HGD progression and promoting LGD regression in BE, and evaluates its safety profile, including complications such as esophageal stricture, bleeding, and perforation. Methods: A systematic search was conducted in PubMed, Embase, Web of Science, Scopus, Cochrane Library, and ClinicalTrials.gov for studies published up to October 2024. Randomized controlled trials (RCTs), prospective trials, and retrospective cohort studies involving BE patients undergoing RFA were included. Data on study characteristics, complications, and outcomes were extracted. Pooled odds ratios (ORs) and 95% confidence intervals (CIs) were calculated for effectiveness outcomes, with prevalence rates for safety outcomes. Results: Seven studies (3654 patients) met inclusion criteria. The pooled log OR for HGD progression was -2.60 (95% CI: [-5.38, 0.18]), suggesting a potential protective effect, though with uncertainty. LGD regression showed a significant pooled log OR of 2.75 (95% CI: [1.37, 4.14]), with high heterogeneity ( I 2 = 83.99%). Esophageal stricture prevalence was 5.84% (95% CI: [4.07, 18.31]), bleeding 1.79% (95% CI: [0.01, 5.63]), perforation 0.79%, and abdominal pain: 1.45%. Conclusions: RFA effectively promotes LGD regression and may prevent HGD progression in BE, though larger RCTs are needed to confirm HGD effects. Generally safe, RFA carries risks of stricture and bleeding, requiring careful patient selection and monitoring. Long-term, diverse studies are essential to assess durability and generalizability.