Efficacy of multipolar electrocoagulation vs. argon plasma coagulation in ablating barrett's esophagus: a meta-analysis.

Introduction: Barrett's esophagus is a major risk factor for developing adenocarcinoma of the esophagus. Esophageal adenocarcinoma, despite recent advances in surgery, is still associated with considerable morbidity and mortality. Several ablative techniques have been reported to produce successful reversal of Barrett's esophagus. Among these techniques, multipolar electrocoagulation (MPEC) and argon plasma coagulation (APC) are considered effective with minimal adverse events.

Objectives: To compare the efficacy and safety of MPEC vs APC in ablating Barrett's esophagus on long-term follow-up.

Search strategy: A comprehensive search was performed using electronic databases from Medline, Embase and Cochrane.

Selection criteria: Randomized controlled trials that compared MPEC vs APC in achieving complete reversal of Barrett's esophagus with at least 24 months of follow-up.

Data collection and analysis: Two reviewers independently assessed the studies for methodological quality. Further treatment of data was performed using meta-analytic software in Review Manager Version 4.2.8.

Main results: Two studies were included in the meta-analysis. The difference of the risk of incomplete endoscopic reversal of the Barrett's esophagus with MPE vs APC was noted not to be statistically significant, with an over-all RR of 0.57 with a 95 percent CI of 0.22-1.45. Comparison of the incidence of adverse events between MPEC vs APC was also found to be not significant, with an over-all RR of 0.89 with a 95 percent CI of 0.38-2.07.

Reviewers' conclusions: There is insufficient statistical evidence to show that MPEC confers better benefits compared to APC in terms of endoscopic ablation of Barrett's esophagus.