Austrian expert panel recommendation for radiofrequency ablation of Barrett’s esophagus

Abstract

Background Barrett's esophagus (BE) represents the premalignant manifestation of gastroesophageal reflux disease and includes columnar lined esophagus with intestinal metaplasia, low-grade dysplasia, high-grade dysplasia and cancer.Methods An Austrian panel of expert meeting was held at the Medical University Vienna, June 2015, to establish and define recommendations for the endoscopic treatment of BE with and without dysplasia and cancer. Recommendations are based on critical analysis of published evidence. Statistics were not applied.Results Diagnosis of cancer and dysplasia is to be reconfirmed by a second expert pathologist. Advanced cancer (> T1a) requires surgical resection ± adjuvant therapies. Treatment of T1a early cancer, high-and lowgrade dysplasia should include endoscopic mucosal resection (EMR) and radiofrequency ablation (RFA). In the presence of increased cancer risk, BE without dysplasia should be treated by RFA within clinical studies only. Elimination of any early cancer, dysplasia and IM defines complete response, that is, post RFA histopathology shows squamous, cardiac or oxyntocardiac mucosa lined esophagus (Chandrasoma classification). Followup endoscopies are timed according to the base line histopathology. Down grade from cancer to dysplasia or from dysplasia to non-dysplastic BE defines partial response, respectively. Based on esophageal function testing, reflux is treated by medical or surgical therapy.Conclusion In Austria, RFA ± EMR is recommended for BE containing early cancer or dysplasia. Non-dysplastic BE with an increased cancer risk should be offered RFA within clinical trials to assess the efficacy for cancer prevention in this group of patients.

Update on the management of Barrett’s esophagus in Austria

“…According to the Chandrasoma classification, CLE includes cardiac mucosa (CM: mucus-cell-only epithelium), oxyntocardiac mucosa (OCM: mixture of mucus and parietal cells within the subfoveolar region of the glands), nondysplastic BE (cardiac mucosa with goblet cells; intestinal metaplasia: IM), LGD, HGD, and cancer ([ 1 , 3 ]; Fig. 2 ).…”

“…Endoscopic therapies for the elimination of BE include endoscopic mucosal and submucosal resection for the removal of nodules and tumors within the CLE [ 3 ]. RFA represents a modern endoscopic therapy for the removal of endoscopically flat visible CLE containing BE, LGD, HGD, and early cancer ([ 2 , 3 ], Figs. 2 and 3 ).…”

“…Via low- (LGD) and high-grade dysplasia (HGD), nondysplastic BE may progress toward adenocarcinoma of the esophagus (risk approx. 0.5% per year; [ 2 , 3 ]; Fig. 2 ).…”

“…Radiofrequency ablation (RFA; Fig. 3 ) and endoscopic mucosal and submucosal resection are treatment modalities for the durable eradication of BE, dysplasia, and early cancer and have been demonstrated to foster cancer prevention [ 2 , 3 ].

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“…A recent Austrian multidisciplinary expert panel meeting held in Vienna in June 2015 summarized recommendations for the management of BE [ 3 ]. Here we aim to summarize and update the recommendation by inclusion of relevant studies published in 2016 until December 2017 from the viewpoint of a high-volume center.…”