Clinical Endoscopy

Systematic Review and Meta-analysis

Cryotherapy versus radiofrequency ablation in the treatment of dysplastic Barrett’s esophagus with or without early esophageal neoplasia: a systematic review and meta-analysis: Igor Logetto Caetité Gomes, Diogo Turiani Hourneaux de Moura, Igor Braga Ribeiro, Sérgio Barbosa Marques, Alexandre de Sousa Carlos, Beanie Conceição Medeiros Nunes, Bruno Salomão Hirsch, Guilherme Henrique Peixoto de Oliveira, Roberto Paolo Trasolini, Wanderley Marques Bernardo, Eduardo Guimarães Hourneaux de Moura; Clin Endosc 2024;57(2):181-190. Published online January 17, 2024; DOI: https://doi.org/10.5946/ce.2023.065

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Background
/Aims: Radiofrequency ablation (RFA) is the first-line therapy for dysplastic Barrett’s esophagus (BE). Therefore, cryotherapy has emerged as an alternative treatment option. This study aimed to compare the efficacies of these two techniques based on the rates of complete eradication of intestinal metaplasia (CE-IM) and dysplasia (CE-D). Adverse events and recurrence have also been reported.
Methods
An electronic search was conducted using the Medline (PubMed), Embase, LILACS, and Google Scholar databases until December 2022. Studies were included comparing cryotherapy and RFA for treating dysplastic BE with or without early esophageal neoplasia. This study was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.
Results
Three retrospective cohort studies involving 627 patients were included. Of these, 399 patients underwent RFA, and 228 were treated with cryotherapy. There was no difference in CE-IM (risk difference [RD], –0.03; 95% confidence interval [CI], –0.25 to 0.19; p=0.78; I2=86%) as well as in CE-D (RD, –0.03; 95% CI, –0.15 to 0.09; p=0.64; I2=70%) between the groups. The absolute number of adverse events was low, and there was no difference in the recurrence rate.
Conclusions
Cryotherapy and RFA were equally effective in treating dysplastic BE, with or without early esophageal neoplasia.

Citations

Citations to this article as recorded by

Barrett's Esophagus
Antonio Al Hazzouri, Philippe Attieh, Tony Azizi, Karl Kfoury, Kelly Katherine Karam, Karam Karam, Elias Fiani
Journal of Gastroenterology and Hepatology.2026; 41(1): 41. CrossRef
Advances in Reversing Gastric Mucosal Atrophy: Pathological Mechanisms, Therapeutic Targets, and Clinical Strategies
Jianlong Chen, Huanlu Xu, Yiwen Feng, Hongzhang Shen
Gastrointestinal Disorders.2026; 8(1): 10. CrossRef
Cryotherapy versus radiofrequency ablation in the treatment of post-chemoradiotherapy patients with recurrence of Barrett’s dysplasia
Shiraz Mohammed Khan, Sirsha Kundu, Jade Godfrey, Claudio Buggiotti, Hasan Haboubi
Clinical Endoscopy.2025; 58(1): 161. CrossRef
High Quality Barrett’s Esophagus Examination and Endoscopic Eradication Therapy
Shirin Dey, Kevin Shah, Srinadh Komanduri
Gastrointestinal Endoscopy Clinics of North America.2025; 35(3): 523. CrossRef
Management of Barrett’s Esophagus in the Context of Achalasia
Margaret J. Zhou, John O. Clarke
Current Gastroenterology Reports.2025;[Epub] CrossRef
Endoscopic Treatment for Early Barrett’s Neoplasia: A Western Perspective
Edward Young, Joseph Fantasia, Eugene Phan, Rajvinder Singh
Digestion.2025; 107(1): 58. CrossRef
Durability of cryoballoon ablation for eradication of neoplastic Barrett's esophagus: a multicenter prospective cohort study (with video)
Marcia Irene Canto, Arvind J. Trindade, Amitabh Chak, John A. Dumot, Prasad G. Iyer, Harshit S. Khara, David L. Diehl, F. Scott Corbett, Eun Ji Shin, Matthew McKinley, Irving Waxman, Anthony Infantolino, Christina J. Tofani, Kenneth J. Chang, Charles J. L
Gastrointestinal Endoscopy.2025;[Epub] CrossRef
Efficacy and Safety of Cryoablation in Barrett’s Esophagus and Comparison with Radiofrequency Ablation: A Meta-Analysis
Apostolis Papaefthymiou, Benjamin Norton, Andrea Telese, Daryl Ramai, Alberto Murino, Paraskevas Gkolfakis, John Vargo, Rehan J. Haidry
Cancers.2024; 16(17): 2937. CrossRef

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5 Web of Science
8 Crossref

Systematic Review and Meta-Analysises

Stent versus Balloon Dilation for the Treatment of Dominant Strictures in Primary Sclerosing Cholangitis: A Systematic Review and Meta-Analysis: Marina Tucci Gammaro Baldavira Ferreira, Igor Braga Ribeiro, Diogo Turiani Hourneaux de Moura, Thomas R. McCarty, Alberto Machado da Ponte Neto, Galileu Ferreira Ayala Farias, Antônio Afonso de Miranda Neto, Pedro Victor Aniz Gomes de Oliveira, Wanderley Marques Bernardo, Eduardo Guimarães Hourneaux de Moura; Clin Endosc 2021;54(6):833-842. Published online July 1, 2021; DOI: https://doi.org/10.5946/ce.2021.052

Abstract PDF PubReader ePub

Background
/Aims: The endoscopic management of primary sclerosing cholangitis (PSC)-associated dominant strictures remains challenging. This systematic review and meta-analysis aimed to compare balloon dilation and stent placement in the treatment of dominant strictures among PSC patients.
Methods
Literature searches on MEDLINE, EMBASE, Cochrane CENTRAL and Lilacs/Bireme were performed for studies published until December 2020. Measured outcomes included clinical efficacy, stricture recurrence, cumulative recurrencefree rate, transplant rate, 5-year survival rate, and adverse events (i.e., pancreatitis, cholangitis, bleeding, perforation and death).
Results
A total of 5 studies (n=467) were included. Based on pooled analyses, there were no differences in clinical efficacy (risk difference [RD], -0.13; 95% confidence interval [CI], -0.58 to 0.33; I²=93%) or transplant rates (RD, -0.09; 95% CI, -0.19 to 0.01; I²=0%); however, the risk of occurrence of adverse events was lower with balloon dilatation than with stent placement (RD,-0.34; 95% CI, -0.45 to -0.23; I²=61%). Among the types of adverse events reported, only the rates of cholangitis/bacteremia were significantly lower in balloon dilation patients (RD, -0.19; 95% CI, -0.25 to -0.13; I²=51%).
Conclusions
Compared to balloon dilation, stent placement for dominant strictures in PSC appeared to have higher complication rates without significant differences in efficacy.

Citations

Citations to this article as recorded by

Primary sclerosing cholangitis
Michael P. Manns, Annika Bergquist, Tom H. Karlsen, Cynthia Levy, Andrew J. Muir, Cyriel Ponsioen, Michael Trauner, Grace Wong, Zobair M. Younossi
Nature Reviews Disease Primers.2025;[Epub] CrossRef
Endoscopic management of primary sclerosing cholangitis
Suguru Mizuno, Yoshihito Uchida, Satsuki Ando, Masamitsu Nakao, Kayoko Sugawara, Nobuaki Nakayama, Yukinori Imai, Tomoaki Tomiya, Satoshi Mochida
Digestive Endoscopy.2025; 37(7): 723. CrossRef
S3-Leitlinie „Seltene Lebererkrankungen (LeiSe LebEr) – Autoimmune Lebererkrankungen von der Pädiatrie bis zum Erwachsenenalter“ der Deutschen Gesellschaft für Gastroenterologie, Verdauungs- und Stoffwechselkrankheiten (DGVS)

Zeitschrift für Gastroenterologie.2025; 63(06): 604. CrossRef
Contribution of Endoscopy in the Diagnosis and Treatment of Patients With Primary Sclerosing Cholangitis
Mamoru Takenaka, Masatoshi Kudo
Digestive Endoscopy.2025; 37(10): 1089. CrossRef
Endoscopic balloon dilation versus stent placement in the management of dominant strictures in primary sclerosing cholangitis: a systematic review and meta-analysis
Archit Garg, Vishali Moond, Aashi Garg, Mehak Bassi, Babu P. Mohan, Arkady Broder, Douglas G. Adler
Gastrointestinal Endoscopy.2025;[Epub] CrossRef
Treatment of Non-Anastomotic Biliary Strictures after Liver Transplantation: How Effective Is Our Current Treatment Strategy?
Florian A. Michael, Mireen Friedrich-Rust, Hans-Peter Erasmus, Christiana Graf, Olivier Ballo, Mate Knabe, Dirk Walter, Christoph D. Steup, Marcus M. Mücke, Victoria T. Mücke, Kai H. Peiffer, Esra Görgülü, Antonia Mondorf, Wolf O. Bechstein, Natalie Filma
Journal of Clinical Medicine.2023; 12(10): 3491. CrossRef
Treatment of primary sclerosing cholangitis combined with inflammatory bowel disease
You Sun Kim, Edward H. Hurley, Yoojeong Park, Sungjin Ko
Intestinal Research.2023; 21(4): 420. CrossRef
Liver Transplantation for Primary Sclerosing Cholangitis (PSC) With or Without Inflammatory Bowel Disease (IBD)—A European Society of Organ Transplantation (ESOT) Consensus Statement
M. Carbone, A. Della Penna, C. Mazzarelli, E. De Martin, C. Villard, A. Bergquist, P. D. Line, J. M. Neuberger, S. Al-Shakhshir, P. J. Trivedi, U. Baumann, L. Cristoferi, J. Hov, B. Fischler, N. H. Hadzic, D. Debray, L. D’Antiga, N. Selzner, L. S. Belli,
Transplant International.2023;[Epub] CrossRef
Primary Biliary Cholangitis and Primary Sclerosing Cholangitis: Current Knowledge of Pathogenesis and Therapeutics
Ji-Won Park, Jung-Hee Kim, Sung-Eun Kim, Jang Han Jung, Myoung-Kuk Jang, Sang-Hoon Park, Myung-Seok Lee, Hyoung-Su Kim, Ki Tae Suk, Dong Joon Kim
Biomedicines.2022; 10(6): 1288. CrossRef
Use a biodegradable stent in ERCP and it will never be forgotten
Jesús García-Cano, Eva de la Santa Belda, Francisco Domper
Revista Española de Enfermedades Digestivas.2022;[Epub] CrossRef
Endoscopic stenting of dominant strictures in patients with primary sclerosing cholangitis: When, how, and for how long?
Il Sang Shin, Jong Ho Moon
Endoscopy International Open.2022; 10(09): E1169. CrossRef

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11 Crossref

Endoscopic Band Ligation Versus Argon Plasma Coagulation in the Treatment of Gastric Antral Vascular Ectasia: A Systematic Review and Meta-Analysis of Randomized Controlled Trials: Bruno Salomão Hirsch, Igor Braga Ribeiro, Mateus Pereira Funari, Diogo Turiani Hourneaux de Moura, Sergio Eiji Matuguma, Sergio A. Sánchez-Luna, Fabio Catache Mancini, Guilherme Henrique Peixoto de Oliveira, Wanderley Marques Bernardo, Eduardo Guimarães Hourneaux de Moura; Clin Endosc 2021;54(5):669-677. Published online May 31, 2021; DOI: https://doi.org/10.5946/ce.2021.063

Abstract PDF Supplementary Material PubReader ePub

Background
/Aims: Argon plasma coagulation (APC) is the most commonly used endoscopic treatment for gastric antral vascular ectasia (GAVE). Endoscopic band ligation (EBL) has emerged as an alternative therapy. Our goal was to evaluate the feasibility, efficacy, and safety of APC and EBL for the treatment of GAVE. This is the first systematic review that included only randomized controlled trials (RCTs) on this topic.
Methods
A comprehensive search was performed using electronic databases to identify RCTs comparing APC and EBL for the treatment of GAVE following the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines.
Results
Four RCTs were included, with a total of 204 patients. EBL was related to higher endoscopic eradication rates risk difference [RD], 0.29; 95% confidence interval [CI] [0.14, 0.44]; I²=0%) and less bleeding recurrence than APC (RD, 0.29; 95% CI [0.15, 0.44]; I²=0%). Patients treated with EBL required fewer blood transfusions (mean difference [MD], 1.49; 95% CI [0.28, 2.71]; I²=96%) and hospitalizations (MD, 0.29; 95% CI [0.19, 0.39]; I²=0%). The number of sessions required for the obliteration of lesions was higher with APC. There was no difference in the incidence of adverse events.
Conclusions
EBL is superior to APC in the treatment of GAVE in terms of endoscopic eradication rates, recurrence of bleeding, and transfusion requirements.

Citations

Citations to this article as recorded by

Risk factors for bleeding from gastric antral vascular ectasia
Sung Hyun Cho, Jinyoung Kim, Hee Kyong Na, Ji Yong Ahn, Jeong Hoon Lee, Kee Wook Jung, Do Hoon Kim, Kee Don Choi, Ho June Song, Gin Hyug Lee, Hwoon-Yong Jung
The Korean Journal of Internal Medicine.2026; 41(1): 74. CrossRef
A Review of Flexible Plasma Jets and Their Applications in Biomedicine
Yajun Zhao, Feng Han, Chang Chang, Shanshan Jin, Zhi Fang
Plasma Processes and Polymers.2026;[Epub] CrossRef
Management of gastrointestinal bleed in the intensive care setting, an updated literature review
Vignesh K Nagesh, Sai Priyanka Pulipaka, Ruchi Bhuju, Emelyn Martinez, Shruthi Badam, Gomathy Aarthy Nageswaran, Hadrian Hoang-Vu Tran, Daniel Elias, Charlene Mansour, Jaber Musalli, Sanket Bhattarai, Lokeash Subramani Shobana, Tannishtha Sethi, Ritvik Se
World Journal of Critical Care Medicine.2025;[Epub] CrossRef
A case report of gastric antral vascular ectasia treated by endoscopic band ligation combined with lauromacrogol injection
Linbo Chen, Keke Sun, Yukai Chen, Pingping Hu, Qi Lin
Medicine.2025; 104(4): e41235. CrossRef
Safety and efficacy of endoscopic band ligation versus argon plasma coagulation in management of gastric antral vascular ectasia: randomized clinical trial
Esraa Y. M. Swifee, Osman A. Osman, Mohamed O Abdel-Malek, Mohamed A Mekky
The Egyptian Journal of Internal Medicine.2025;[Epub] CrossRef
Endoscopic band ligation versus argon plasma coagulation in the treatment of gastric antral vascular ectasia: systematic review and meta-analysis
Archit Garg, Vishali Moond, Khyati Bidani, Aashi Garg, Arkady Broder, Babu P. Mohan, Douglas G. Adler
Gastrointestinal Endoscopy.2025; 101(6): 1100. CrossRef
Co-occurrence of Gastric Xanthoma and Numerous Large Hyperplastic Polyps as a Complication of Argon Plasma Coagulation in GAVE
Elona Poltiyelova, Natalie Balassiano, Saphwat L. Eskaros
ACG Case Reports Journal.2025; 12(6): e01728. CrossRef
A Case Report and Literature Review on Systemic Sclerosis Manifesting as Melena and Hematochezia
Anthony El Gharib, Léa Nassif, Karam Karam, Elias Fiani
Journal of Investigative Medicine High Impact Case Reports.2025;[Epub] CrossRef
Role of endoscopy in the diagnosis and treatment of gastric mucosal lesions in liver cirrhosis patients
Elena R Olevskaya, Anastasia I Dolgushina, Dmitry V Garbuzenko, Alina O Khikhlova, Anna A Saenko, Guzel M Khusainova, Alla S Kuznetsova
World Journal of Gastrointestinal Endoscopy.2025;[Epub] CrossRef
Frayed to Fury: Argon Plasma Coagulation for Trapezoid Basket Retrieval in the Pancreatic Duct
Noval Zakaria, Muhammad Umair Tahseen, Mehreen Siyal, Saad Khalid Niaz, Arif Siddiqui, Muhammad Asim
ACG Case Reports Journal.2025;[Epub] CrossRef
Endoscopic Treatments for Portal Hypertensive Gastropathy (PHG) and Gastric Antral Vascular Ectasia (GAVE)
Ali Khalifa, Don C. Rockey
Current Hepatology Reports.2025;[Epub] CrossRef
Rapidly Progressive Coexistence of Gastric Antral Vascular Ectasia (GAVE) and Portal Hypertensive Gastropathy (PHG) Presenting With Iron Deficiency Anaemia: Successful Use of PuraStat in a Patient With Implantable Cardioverter-Defibrillator (ICD)
Mohamed Alafifi, Mariam Shata, Karim Heiba, Amany Emara
Cureus.2025;[Epub] CrossRef
Role of Endoscopy in the Diagnosis, Grading, and Treatment of Portal Hypertensive Gastropathy and Gastric Antral Vascular Ectasia
Ali Khalifa, Don C. Rockey
Gastrointestinal Endoscopy Clinics of North America.2024; 34(2): 263. CrossRef
Review article: Upper gastrointestinal bleeding – review of current evidence and implications for management
Dennis L. Shung, Loren Laine
Alimentary Pharmacology & Therapeutics.2024; 59(9): 1062. CrossRef
A delayed gastric antral vascular ectasia: A case report and literature review
Zheke Fang, Jiajie Zhu, Zheng Fang, Qiang Hu, Liangjun Yang
Medicine.2024; 103(52): e40831. CrossRef
Bevacizumab in combination with octreotide rescues a patient with liver cirrhosis, GAVE syndrome and refractory hemorrhage – a case report
Simon Johannes Gairing, Eva Maria Schleicher, Lukas Müller, Christian Labenz, Felix Darstein, Daniel Grimm, Visvakanth Sivanathan, Arndt Weinmann, Marcus-Alexander Wörns, Roman Kloeckner, Michael B. Pitton, Florian Thieringer, Khan Fareed Rahman, Peter Ro
Zeitschrift für Gastroenterologie.2023; 61(03): 275. CrossRef
A Practical Approach to the Management of Gastric Antral Vascular Ectasia
Matthew H. Meyers, Laura Rodriguez, Michael S. Kriss
American Journal of Gastroenterology.2023; 118(9): 1532. CrossRef
Endoscopic Advances in Hepatology
Emma Vanderschueren, Jonel Trebicka, Wim Laleman
Seminars in Liver Disease.2023; 43(02): 176. CrossRef
Comparisons Between Endoscopic Band Ligation, Radiofrequency Ablation and Endoscopic Thermal Therapy for Gastric Antral Vascular Ectasia: A Meta-Analysis
Cheng-Che Che, Sz-Iuan Shiu, Chung-Wang Ko, Yu-Kang Tu, Chung-Hsin Chang
Digestive Diseases and Sciences.2023; 68(9): 3534. CrossRef
An update on the management of non-variceal upper gastrointestinal bleeding
Ali A Alali, Alan N Barkun
Gastroenterology Report.2022;[Epub] CrossRef
Endoscopic band ligation in the treatment of gastric antral vascular ectasia: a systematic review and meta-analysis
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Gastrointestinal Endoscopy.2021; 94(6): 1021. CrossRef

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294 Download
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21 Crossref

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