Radiofrequency ablation offers a Reliable Surgical Modality for the Treatment of Barrett's Esophagus with a Minimal Learning Curve

Abstract

Radiofrequency ablation (RFA) has gained popularity as treatment for Barrett's esophagus. Inclusive series of patients from initiation of our Barrett's Therapy Program were studied. Review of patients undergoing RFA for Barrett's was performed from September 2008 to May 2011. Patients’ outcomes were recorded and analyzed using standard statistical methods. Seventy patients were treated. Average age was 61 (28–70); 80 per cent were male. Seventy-four per cent had dysplasia; 44 low-grade and eight high-grade. A total of 75.7 per cent of patients had long and 24.3 per cent had short segment Barrett's. Procedures per patient ranged from one to seven. Number of treatments in long- and short-segment groups were not different ( P = 0.11). The maximum number of treatments in the short-segment group was five with a median of three (44.3%). For long segment, the maximum of RFA procedures was seven, with a median of three (30.8%). Average procedure time was 20.8 minutes for long and 17.9 minutes for short segment. Mean follow-up was 16.1 (2–38) months. Complete response was accomplished in 81 per cent. There were 93.3 per cent of complete responders in the short-segment group versus 75 per cent in the long ( P = 0.24). Complications included dysphagia (1), transient chest and cervical pain (1), and abdominal pain (1). Comparing the first 25 per cent of the RFA procedures to the later 75 per cent or first 50 per cent to second 50 per cent, there was no difference in operative time or complications. Two patients recurred, both in the long-segment group. RFA is a safe and effective means to eradicate Barrett's. By measure of treatment time, complication rate, and efficacy of therapy, there is minimal or no “learning curve” for experienced endoscopists.

Radiofrequency Ablation Versus Endoscopic Submucosal Dissection in Treating Large Early Esophageal Squamous Cell Neoplasia

“…To be able to perform ESD well and safely involves a significant learning curve, 24 which has limited the use of this technique worldwide and explains why it is only used in select high-volume centers. However, RFA appears to be less technically demanding, with a minimal learning curve 25 compared with ESD, and thus may be more feasible for less experienced endoscopists. RFA is already the first treatment of choice for dysplasia in cases of Barrett's esophagus in many countries.…”

Nonthermal resection device for ablation of Barrett’s esophagus: a feasibility and safety study

“…Additionally, device malfunctions occurred during five procedures, all requiring replacement of the EndoRotor catheter. Finally, EndoRotor ablation was more time-consuming than RFA and cryotherapy, especially for longer Barrett’s segments 12 30 31 . Histological assessment of resected tissue was of limited value, as this did not alter patient management.…”

“…All rights reserved. [12,30,31] Histological assessment of resected tissue was of limited value, as this did not alter patient management.…”

Endoscopic radiofrequency ablation therapy for the prevention of esophageal cancer in Barrett’s esophagus

“…The length of the Barrett's esophagus segment seems to be associated with higher rates of recurrence. 67,70,80,81 For example, at 3 years follow-up, recurrent intestinal metaplasia was reported in 18% of patients who underwent ablation of long segment Barrett's esophagus (mean length, 4.7 cm) vs 35% of patients with ultralong segment disease (mean length, 10.8 cm), although none of the recurrences in this study were associated with dysplasia. 81 However, it has also been hypothesized that these patients did not actually have recurrent Barrett's esophagus after complete eradication, but rather presented with "recurrent" disease from so-called buried islands of Barrett's esophagus which were not successfully ablated during initial treatment, ie, the original Barrett's esophagus was not fully eradicated.…”