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

Abstract

Background Radiofrequency ablation is safe and effective for complete eradication of nondysplastic Barrett esophagus (BE). The aim was to report the combined results of two published and two ongoing studies on radiofrequency ablation of BE with early neoplasia, as presented at SSAT presidential plenary session DDW 2008. Methods Enrolled patients had BE ≤12 cm with early neoplasia. Visible lesions were endoscopically resected. A balloonbased catheter was used for circumferential ablation and an endoscope-based catheter for focal ablation. Ablation was repeated every 2 months until the entire Barrett epithelium was endoscopically and histologically eradicated. Results Forty-four patients were included (35 men, median age 68 years, median BE 7 cm). Thirty-one patients first underwent endoscopic resection [early cancer (n=16), high-grade dysplasia (n=12), low-grade dysplasia (n=3)]. Worst histology remaining after resection was high-grade (n=32), low-grade (n=10), or no (n=2) dysplasia. After ablation, complete histological eradication of all dysplasia and intestinal metaplasia was achieved in 43 patients (98%). Complications following ablation were mucosal laceration at resection site (n=3) and transient dysphagia (n=4). After 21 months of follow-up (interquartile range 10-27), no dysplasia had recurred. Conclusions Radiofrequency ablation, with or without prior endoscopic resection for visible abnormalities, is effective and safe in eradicating BE and associated neoplasia.

Efficacy and Durability of Cryospray Ablation for Dysplastic Barrett’s Esophagus

“…EMR has been shown to be successful following cryospray ablation therapy but not as feasible following radiofrequency ablation [9,23]. Our study demonstrated similar technical success of EMR in three cases following cryospray ablation.…”

Epidemiology of esophageal cancer

“…In one trial of photodynamic therapy plus proton-pump inhibitors compared with proton-pump inhibitors alone, progression to cancer was significantly decreased in the photodynamic-therapy group (13% vs 28%). In the other, which assessed endoscopic radiofrequency ablation in patients with Barrett' s esophagus and high-grade dysplasia, radio frequency ablation was more effective in eradication of high-grade dysplasia than a proton-pump inhibitor alone, and the progression to cancer was lower (4% vs 22%) during short-term follow-up [74][75][76][77] .…”

Diagnosis and Management of Barrett’s Esophagus with and Without Dysplasia

“…Buried Barrett's glands have been evaluated in all RFA studies showing positive result in one of 5000 biopsies. Re-EMR specimens after ablation did not show any buried glands [237]. Neo-squamous epithelium on EMR specimens in a group of 22 post-RFA patients with baseline BE with IMC or HGD showed no evidence of persistent genetic abnormalities or buried BE glands [243].…”

“…Stricture formation rate was up to 6%, much lower than the rate associated with EMR [234]. In combination with EMR complications are found more frequently [237,238]. Nontransmural laceration associated with circumferential RFA following EMR was observed in 7% of patients, which occurred only at the level of the EMR.…”

“…The results of these studies showed that eradication rate of IM, any dysplasia, including also HGD was in 46%-100%, and 71%-100% respectively. [230,232,[234][235][236][237][238][239][240]. In one study 44 patients with LGD, HGD, or IMC treated with RFA (31 patients had prior EMR for visible lesions before RFA) were evaluated [237].…”