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Tytuł pozycji:

Efficacy of cryotherapy as first line therapy in patients with Barrett's neoplasia: a systematic review and pooled analysis.

Tytuł :
Efficacy of cryotherapy as first line therapy in patients with Barrett's neoplasia: a systematic review and pooled analysis.
Autorzy :
Hamade N; Gastroenterology and Hepatology.
Desai M; Department of Internal Medicine, University of Kansas Medical Center, Kansas City, KS.
Thoguluva Chandrasekar V; Gastroenterology and Hepatology.; Department of Internal Medicine, University of Kansas Medical Center, Kansas City, KS.
Chalhoub J; Division of gastroenterology, baystate medical center.
Patel M; Gastroenterology and Hepatology.
Duvvuri A; Gastroenterology and Hepatology.
Gorrepati VS; Gastroenterology and Hepatology, Kansas City VA Medical Center, Kansas City, MO.
Jegadeesan R; Gastroenterology and Hepatology.
Choudhary A; Division of gastroenterology, kansas city veteran's affair medical center.
Sathyamurthy A; Gastroenterology and Hepatology, Kansas City VA Medical Center, Kansas City, MO.
Rai T; Gastroenterology and Hepatology, Kansas City VA Medical Center, Kansas City, MO.
Gupta N; Gastroenterology and Hepatology, Loyola University Medical Center, Maywood, IL, USA.
Sharma P; Gastroenterology and Hepatology, Kansas City VA Medical Center, Kansas City, MO.
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Źródło :
Diseases of the esophagus : official journal of the International Society for Diseases of the Esophagus [Dis Esophagus] 2019 Dec 30; Vol. 32 (11).
Typ publikacji :
Journal Article; Meta-Analysis; Systematic Review
Język :
English
Imprint Name(s) :
Publication: 2017- : New York : Oxford University Press
Original Publication: Milano : Masson, 1988-
MeSH Terms :
Cryosurgery*/adverse effects
Neoplasm Recurrence, Local*
Barrett Esophagus/*surgery
Esophageal Neoplasms/*surgery
Barrett Esophagus/pathology ; Esophageal Neoplasms/pathology ; Esophageal Stenosis/etiology ; Humans ; Recurrence ; Treatment Outcome
Contributed Indexing :
Keywords: Barrett's esophagus; ablation; cryotherapy; efficacy
Entry Date(s) :
Date Created: 20190512 Date Completed: 20200522 Latest Revision: 20200522
Update Code :
20201023
DOI :
10.1093/dote/doz040
PMID :
31076753
Czasopismo naukowe
Cryotherapy has been used as salvage therapy; however, its efficacy as first line treatment in patients with Barrett's esophagus (BE) neoplasia has not been well studied. The aim of this paper was to perform a systematic review to look at the efficacy of cryotherapy as the primary treatment of BE. An electronic database search was performed (PubMed, Embase, Cochrane, and Google Scholar) to search for studies with cryotherapy as the initial primary modality of ablation in patients with BE neoplasia. Studies that included patients with other prior forms of therapy were excluded. The primary outcomes were the pooled rates of complete eradication of intestinal metaplasia (CE-IM) and CE of neoplasia (CE-N). Secondary outcomes were recurrence rates of neoplasia and intestinal metaplasia (IM) and adverse events. The statistical software OpenMetaAnalyst was used for analysis with pooled estimates reported as proportions (%) with 95% confidence intervals (CI) with heterogeneity (I2) among studies. The search revealed 6 eligible studies with a total of 282 patients (91.5% male, average age 65.3 years) with 459 person years of follow-up. 69.35% [95% CI (52.1%-86.5%)] of patients achieved CE-IM and 97.9% (95% CI: 95.5%-100%) had CE-N. 7.3% of patients had persistent dysplasia with 4% progressing to cancer. The recurrence rate of neoplasia was 10.4 and that of IM was 19.1 per 100 patient years of follow-up. The overall rate of stricture formation was 4.9%. There are scarce data on the use of cryotherapy as the primary modality for the treatment of BE dysplasia. The published data demonstrate efficacy rates of 69% and 98% for complete eradication of metaplasia and neoplasia, respectively. These results need to be assessed in prospective, comparative trials with other forms of therapy.
(© The Author(s) 2019. Published by Oxford University Press on behalf of International Society for Diseases of the Esophagus. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

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