Abstract
Radiofrequency ablation (RFA) is the first-line endoscopic eradication therapy for Barrett’s esophagus (BE). Quantifying esophageal adenocarcinoma (EAC) risk after RFA informs post-treatment surveillance. We performed a systematic review and meta-analysis to estimate EAC incidence rates after RFA.
PubMed, Embase, and Web of Science were searched through February 2026 for studies reporting incident EAC and person-years after RFA. Random-effects meta-analysis pooled incidence rates per 1,000 person-years (PY). Primary analyses anchored follow-up at complete eradication of intestinal metaplasia (CEIM); sensitivity analyses anchored follow-up at first RFA and pooled all studies regardless of time zero. Cumulative EAC incidence was pooled by baseline histology.
Eleven studies including 8,633 patients and 25,458 PY were included. Across studies reporting demographics, mean age was 62.4 years and 75.4% were male. Baseline histology among 8,263 patients was 32.5% non-dysplastic BE, 4.4% indefinite for dysplasia, 21.2% low-grade dysplasia, 29.7% high-grade dysplasia, 12.2% intramucosal carcinoma, and 0.1% baseline EAC.
After achieving CEIM (5 studies), the pooled EAC incidence was 2.18/1,000 PY (95% CI, 0.15–4.21; I2=22.7%). Following the first RFA session (6 studies), incidence was 6.25/1,000 PY (95% CI, 4.59–7.91; I2=3.7%). When all studies were pooled, incidence was 4.45/1,000 PY (95% CI, 2.49–6.42; I2=70.8%). Over a mean follow-up of 2.9 years, cumulative EAC incidence was 0.32% in NDBE, 2.02% in LGD, and 3.84% in HGD.
EAC incidence after RFA for BE was low, particularly after achieving CEIM. This data provides reassuring post-eradication cancer risk estimates while underscoring the need for ongoing surveillance.