S889 Comparative Efficacy and Safety of Radiofrequency Ablation vs Cryoablation for Dysplastic Barrett’s Esophagus: A Systematic Review and Meta-Analysis

Introduction: Barrett’s esophagus (BE), a premalignant condition arising from chronic gastroesophageal reflux disease (GERD), carries a substantial risk of progression to esophageal adenocarcinoma. Endoscopic ablative therapies, including radiofrequency ablation (RFA) and cryoablation, are widely used to eradicate dysplastic BE. Although both modalities are routinely used, their comparative efficacy and safety profiles remain subjects of ongoing investigation. Methods: We performed a systematic review and meta-analysis in accordance with PRISMA guidelines. A thorough literature search was conducted across PubMed, Embase, Scopus, and the Cochrane Library up to May 2025. Studies were eligible if they directly compared RFA and cryoablation in adult patients diagnosed with dysplastic BE. Primary outcomes assessed were complete eradication of dysplasia (CE-D) and complete eradication of intestinal metaplasia (CE-IM). Secondary outcomes included recurrence, adverse events, and post-procedural stricture formation. A random-effects model was used to calculate pooled effect sizes. Heterogeneity was assessed using the I² statistic. Results: A total of 3,114 patients across 12 studies were analyzed in our meta-analysis to compare efficacy and safety of RFA with cryoablation in BE. RFA showed a slight advantage over cryoablation in achieving CE-D (relative risk [RR] 1.05; 95% confidence interval [CI] 1.01-1.08; P = 0.0072; I² = 0%) and CE-IM (RR 1.06; 95% CI 1.00-1.11; P = 0.0329; I² = 0%), which are statistically significant. However, RFA was associated with a significantly higher risk of post-procedural stricture formation (RR 2.41; 95% CI 1.65-3.51; P < 0.0001; I² = 0%). All analysis showed no heterogeneity, supporting that these findings are consistent among the studies. Conclusion: RFA offers marginally higher dysplasia and intestinal metaplasia eradication rates compared to cryoablation but at the cost of a significantly increased risk of strictures. Treatment choice should be individualized based on patient characteristics and procedural risk profiles.