Twelve RCTs were included in the review (n=at least 747). Jadad scores were 2 in seven RCTs, 3 in three RCTs, 4 in one RCT and 5 in one RCT. Allocation concealment was through sealed envelopes in five of 12 RCTs and unclear in the remainder.
Medical versus surgical (one RCT): Oesophagitis and stricture was higher with medical treatment than surgical treatment (p<0.05) and no patients demonstrated complete regression of intestinal metaplasia. There was a significant decrease in the length of the Barrett's segment (p<0.05) and length of time with a pH less than 4 (p<0.05). A higher incidence of dysplasia de novo was found in the medical group (20% versus 2%, p<0.05). There was no difference between treatments with respect to malignancy.
Proton pump inhibitors versus H2 receptor antagonists (one RCT): Only omeprazole was associated with a statistically significant regression in Barrett's oesophagus in length (6.4%) and area (7.9%) compared to ranitidine. There was a significant difference in the regression of area of Barrett's oesophagus between the two drugs (p=0.02).
Photodynamic therapy versus proton pump inhibitors (two RCTs reported in three publications): One trial reported a significantly greater decrease in Barrett's oesophagus area with photodynamic therapy (30% versus 0%, p<0.001) in patients with low grade dysplasia. Persistent low grade dysplasia was found in 12 patients in the omeprazole group (p<0.001). Another trial found photodynamic therapy was superior to omeprazole in terms of ablation (52% version 7%, p<0.0001) and progression to cancer (13% versus 29%, p=0.006). After five years, occurrence of cancer was significantly lower in the photodynamic therapy group (15% versus 29%, p=0.027) and had a longer time to progression with photodynamic therapy (p=0.004). Common photodynamic therapy-related side effects were photosensitivity reactions, oesophageal strictures and chest pain.
Argon plasma coagulation versus surveillance (two RCTs): One RCT reported complete regression in 55% of patients with argon plasma coagulation and 15% of surveillance patients (p<0.05). Another study reported complete regression in eight of 20 argon plasma coagulation patients versus three of 20 surveillance patients at fiive-year follow-up (p>0.05). One study showed minor side effects in argon plasma coagulation patients, but no serious complication; the other study found late oesophageal strictures in two patients.
Argon plasma coagulation versus photodynamic therapy (four RCTs, three included in meta-analysis): Argon plasma coagulation was associated with greater incidence of complete ablation than photodynamic therapy (59% versus 27.5%, odds ratio 3.46, 95% CI: 1.67 to 7,81, p=0.0008; three RCTs). Complications with either treatment were limited and usually mild. There was no statistical heterogeneity (I2=0).
Argon plasma coagulation versus multipolar electrocoagulation (two RCTs): There was no significant difference in the incidence of histologically complete reversal of Barrett's oesophagus with argon plasma coagulation compared to multipolar electrocoagulation (odds ratio 2.01, 95% CI: 0.77 to 5.23, p=0.15; two RCTs). No severe treatment-related complications were reported in either trial. There was no statistical heterogeneity (I2=0).