Effective treatment of early Barrett’s neoplasia with stepwise circumferential and focal ablation using the HALO system

Eradication of Barrett Esophagus with Early Neoplasia by Radiofrequency Ablation, with or without Endoscopic Resection

“…Of these, 23 patients were treated in the first two pilot studies worldwide to evaluate the use of stepwise circumferential and focal ablation of BE with HGD/EC after prior ER of any visible abnormalities and EC. 26,27 The other 21 patients were included for the first European multicenter study on RFA of BE up to 12 cm containing HGD/EC, 31 or in an ongoing study comparing SRER with RFA in patients with early neoplasia in BE < 5 cm. In all four studies, it was protocolized that any visible lesions and EC had to be removed with ER prior to ablation to enable histological evaluation for accurate staging of the infiltration depth and tumor differentiation and to ensure that subsequent RFA could be performed on an endoscopically flat mucosa.…”

“…In addition, patients with prior piecemeal ER of visible lesions were also included. 27 3. The first ongoing European multicenter trial to evaluate the safety and efficacy of RFA in patients with a Barrett segment up to 12 cm long, with early neoplasia, with or without prior ER.…”

“…The ablation zone was also rinsed with water through the spraying channel of the endoscope. For the next 12 patients, 27 the ablation catheter was removed and the electrode surface was cleaned outside the patient. The ablation zone was more rigorously cleaned compared to the first trial by forcefully spraying water through a spraying catheter using a pressure pistol (Alliance™, Boston Scientific, Limerick, Ireland, UK).…”

“…Eleven patients were included in the first published trial on RFA, 26 12 patients in the second published trial, 27 nine patients in the ongoing European multicenter trial, 31 and 12 patients were randomized to RFA in the ongoing randomized trial comparing RFA with SRER. A total of 36 ER procedures were performed in 31 patients prior to ablation.…”

“…[22][23][24] Subsequently, RFA has been proven safe and effective for the eradication of dysplasia and IM in a number of clinical trials involving patients without dysplasia, with LGD or HGD, and after ER of EC and visible lesions. [25][26][27] In addition, no buried Barrett glands have been found in over 4,000 neosquamous biopsies obtained during follow-up, [25][26][27] oncogenetic abnormalities as present in the pretreatment BE are absent in the regenerated neosquamous epithelium after RFA, 28 and the functional integrity of the esophagus is not affected by RFA. 29 In this paper, we will present the results reported in Abstract 215, which was selected for oral presentation during the SSAT presidential plenary A session, at the Digestive Disease Week 2008, San Diego, CA, USA.…”