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Introduction Endoscopic eradication therapy (EET), combining endoscopic mucosal resection (EMR) and radiofrequency ablation (RFA), is the standard treatment for dysplastic Barrett’s oesophagus (BO) and early oesophageal adenocarcinoma. However, the long-term durability of remission and recurrence risk remain incompletely defined. This systematic review and meta-analysis evaluated the efficacy and long-term outcomes of EET for BO-related neoplasia.Methods MEDLINE (n=1364), Embase (n=443), and SCOPUS (n=2805) were searched from inception to 20 July 2025 for studies reporting long-term outcomes following EET for dysplastic BO. Primary endpoints were complete remission of intestinal metaplasia (CR-IM) and dysplasia (CR-D), and recurrence during surveillance. Proportions were pooled using a random-effects (DerSimonian–Laird) model with logit transformation.Results Eight studies including 3,367 patients and ~7,500 person-years of follow-up were included (median follow-up 39.5 months). Pooled CR-IM was 86.4% (95% CI: 81.2–90.5%; N=3,245) and CR-D 94.0% (95% CI: 91.2–96.1%; N=3,245). Among patients achieving CR-IM, intestinal metaplasia recurred in 14.0% (95% CI: 8.0–23.5%; N=1,997) and dysplasia in 5.6% (95% CI: 3.5–8.9%; N=3,028). Any recurrence occurred in 18.5% (95% CI: 12.3–26.8%), corresponding to an annual dysplasia recurrence rate of ~1.5 per 100 person-years. Heterogeneity was substantial (I 2=76–94%). Dysplasia recurrence was lower after EMR+RFA than RFA alone (4.2% vs 8.9%; RR 2.1, p=0.022) and lower in baseline low-grade dysplasia than HGD/T1a (3.1% vs 6.8%; RR 2.2, p=0.043). Progression to advanced disease occurred in 6–12% of recurrences, mostly managed endoscopically. Sensitivity analyses confirmed result robustness. Temporal analyses showed improved CR-IM and reduced recurrence over time. Meta-regression showed a weak, non-significant association between BO length and dysplasia recurrence.Conclusions EET achieves high remission rates with favourable long-term durability. Recurrence is not uncommon but usually detected early and endoscopically manageable, supporting continued long-term surveillance, particularly after RFA alone.Abstract P40 Figure 1Forest plot showing pooled proportion of intestinal metaplasia recurrence after endoscopic eradication therapy for barrett’s oesophagus