Endoscopic eradication therapy for patients with Barrett’s esophagus–associated dysplasia and intramucosal cancer Sachin Wani, MD, Bashar Qumseya, MD,

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Endoscopic eradication therapy for patients with Barrett’s esophagus–associated dysplasia and intramucosal cancer Sachin Wani, MD, Bashar Qumseya, MD, MPH, Shahnaz Sultan, MD, Deepak Agrawal, MD, Vinay Chandrasekhara, MD, Ben Harnke, PhD, Shivangi Kothari, MD, Martin McCarter, MD, Aasma Shaukat, MD, MPH, Amy Wang, MD, Julie Yang, MD, John Dewitt, MD Gastrointestinal Endoscopy Volume 87, Issue 4, Pages 907-931.e9 (April 2018) DOI: 10.1016/j.gie.2017.10.011 Copyright © 2018 Terms and Conditions

Figure 1 Forest plot of the proportion of cases in which pathologic review resulted in a change in the diagnosis among patients with Barrett’s esophagus. CI, Confidence interval. Gastrointestinal Endoscopy 2018 87, 907-931.e9DOI: (10.1016/j.gie.2017.10.011) Copyright © 2018 Terms and Conditions

Figure 2 Forest plot with 2 randomized controlled trials comparing radiofrequency ablation with surveillance with pooled relative risk of disease progression in Barrett’s esophagus patients with low-grade dysplasia. CI, Confidence interval. Gastrointestinal Endoscopy 2018 87, 907-931.e9DOI: (10.1016/j.gie.2017.10.011) Copyright © 2018 Terms and Conditions

Figure 3 Forest plot highlighting the pooled cumulative rate of disease progression in Barrett’s esophagus patients with low-grade dysplasia treated with radiofrequency ablation compared with those undergoing surveillance. CI, Confidence interval (Reprinted with permission from: Qumseya BJ, Wani S, Gendy S, et al. Disease progression in Barrett's low-grade dysplasia with radiofrequency ablation compared with surveillance: systematic review and meta-analysis. Am J Gastroenterol 2017;112:849-65). Gastrointestinal Endoscopy 2018 87, 907-931.e9DOI: (10.1016/j.gie.2017.10.011) Copyright © 2018 Terms and Conditions

Figure 4 Forest plot with 2 randomized controlled trials comparing endoscopic eradication therapies (radiofrequency ablation and photodynamic therapy) with surveillance with the pooled relative risk of disease progression in Barrett’s esophagus patients with high-grade dysplasia. CI, Confidence interval. Gastrointestinal Endoscopy 2018 87, 907-931.e9DOI: (10.1016/j.gie.2017.10.011) Copyright © 2018 Terms and Conditions

Figure 5 Forest plot of studies providing an indirect comparison of cumulative rates of disease progression between Barrett’s esophagus patients with high-grade dysplasia treated with radiofrequency ablation compared with those undergoing surveillance. CI, Confidence interval. Gastrointestinal Endoscopy 2018 87, 907-931.e9DOI: (10.1016/j.gie.2017.10.011) Copyright © 2018 Terms and Conditions

Figure 6 Forest plot with studies reporting adverse events in Barrett’s esophagus patients with high-grade dysplasia/intramucosal esophageal adenocarcinoma treated with radiofrequency ablation with or without EMR. CI, Confidence interval. Gastrointestinal Endoscopy 2018 87, 907-931.e9DOI: (10.1016/j.gie.2017.10.011) Copyright © 2018 Terms and Conditions

Figure 7 Forest plot of studies comparing overall 5-year survival between Barrett’s esophagus patients with high-grade dysplasia/intramucosal cancer treated with endoscopic eradication therapy and esophagectomy. CI, Confidence interval. Gastrointestinal Endoscopy 2018 87, 907-931.e9DOI: (10.1016/j.gie.2017.10.011) Copyright © 2018 Terms and Conditions

Figure 8 Forest plot of studies reporting the change in diagnosis based on EMR of visible lesions in Barrett’s esophagus patients. CI, Confidence interval. Gastrointestinal Endoscopy 2018 87, 907-931.e9DOI: (10.1016/j.gie.2017.10.011) Copyright © 2018 Terms and Conditions

Figure 9 Decision tool with an algorithmic approach to management of Barrett’s esophagus patients referred for endoscopic eradication therapy. EET, Endoscopic eradication therapy; BE, Barrett’s esophagus. Gastrointestinal Endoscopy 2018 87, 907-931.e9DOI: (10.1016/j.gie.2017.10.011) Copyright © 2018 Terms and Conditions

Supplementary Figure 1 Progression rates in Barrett’s esophagus patients with low-grade dysplasia based on expert pathology review. A, Forest plot of pooled cumulative progression rates stratified by expert pathology review. B, Forest plot of pooled incidence rate of disease progression based on expert pathology review. CI, Confidence interval (Reprinted with permission from: Qumseya BJ, Wani S, Gendy S, et al. Disease progression in Barrett's low-grade dysplasia with radiofrequency ablation compared with surveillance: systematic review and meta-analysis. Am J Gastroenterol 2017;112:849-65). Gastrointestinal Endoscopy 2018 87, 907-931.e9DOI: (10.1016/j.gie.2017.10.011) Copyright © 2018 Terms and Conditions

Supplementary Figure 2 Forest plot of 37 studies with overall adverse events for patients with Barrett’s esophagus undergoing radiofrequency ablation with or without EMR. CI, Confidence interval (Reprinted with permission from: Qumseya BJ, Wani S, Desai M, et al. Adverse events after radiofrequency ablation in patients with Barrett's esophagus: a systematic review and meta-analysis. Clin Gastroenterol Hepatol 2016;14:1086-95.e6). Gastrointestinal Endoscopy 2018 87, 907-931.e9DOI: (10.1016/j.gie.2017.10.011) Copyright © 2018 Terms and Conditions

Supplementary Figure 3 Forest plots of proportion of patients achieving complete eradication of neoplasia after focal EMR followed by radiofrequency ablation (A) compared with stepwise EMR of entire Barrett’s esophagus segment (B) and complete eradication of intestinal metaplasia after focal EMR followed by radiofrequency ablation (C) compared with stepwise EMR (D). C.I., Confidence interval (Reprinted with permssion from: Desai M, Saligram S, Gupta N, et al. Efficacy and safety outcomes of multimodal endoscopic eradication therapy in Barrett's esophagus-related neoplasia: a systematic review and pooled analysis. Gastrointest Endosc 2016;85:482-95). Gastrointestinal Endoscopy 2018 87, 907-931.e9DOI: (10.1016/j.gie.2017.10.011) Copyright © 2018 Terms and Conditions

Supplementary Figure 4 Forest plot with overall pooled incidence of any recurrence (intestinal metaplasia or dysplasia) after achieving complete eradication of intestinal metaplasia after endoscopic eradication therapy using stepwise complete endoscopic resection or radiofrequency ablation with or without focal EMR. CI, Confidence interval (Reprinted with permission from: Fujii-Lau et al. Recurrence of intestinal metaplasia and early neoplasia after endoscopic eradication therapy for Barrett's esophagus: a systematic review and meta-analysis. CC BY-NC-ND 4.0. Endosc Int Open 2017;05(06):E430-E449. https://doi.org/10.1055/s-0043-106578. © Georg Thieme Verlag KG 2017). Gastrointestinal Endoscopy 2018 87, 907-931.e9DOI: (10.1016/j.gie.2017.10.011) Copyright © 2018 Terms and Conditions