Balloon-based, circumferential, endoscopic radiofrequency ablation of Barrett's esophagus: 1-year follow-up of 100 patients (with video)

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

“…Although this hypothesis cannot be confirmed, the 0.07% of subsquamous IM still compares favorably to the 53% rate of buried glands reported after other ablation techniques. [14][15][16][17][18][19][20][21] Our findings were in concordance with the absence of buried glands in 3,007 neosquamous biopsies after RF ablation in the 100 patients described by Sharma et al 25 Further studies on the adequacy of biopsies from the neosquamous epithelium after RFA should, however, clarify this issue further. Ablation at the GE-junction using the HALO 360 catheter may be difficult, since the often tortuous course of the distal esophagus and widening into a hiatal hernia, present in most BE patients, may impede good circumferential contact of the electrode with the mucosa at this level.…”

“…These results are in concordance with the USA multicenter ablation of IM study, where no strictures were reported in 100 patients treated with RFA. 25 The absence of submucosal scarring as a result of RFA was also illustrated by our ability, in three patients, to remove focal areas of persistent Barrett mucosa after multiple ablation sessions using the multiband mucosectomy technique, without the need for submucosal lifting in three patients. This is a significant advantage compared to other endoscopic ablation techniques, after which escape treatment using ER is usually difficult as a result of submucosal scarring.…”

“…[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.…”

Radiofrequency Ablation of Barrett’s Esophagus: Let’s Not Get Ahead of Ourselves

“…The research work on RFA performed to date has involved a stepwise progression from initial animal studies to human studies prior to esophagectomy, human dosimetry studies, single-center studies, multicenter nonrandomized studies, and ultimately multicenter, randomized, controlled trials [1][2][3][4][5]. This process also led to modifications in the RFA technique and to the development of the focal ablation device.…”

Cancer Risk Assessment and Cancer Prevention: Promises and Challenges

“…Endoscopic clinics are filled with Barrett's patients with a low or no risk of developing esophageal adenocarcinoma, and prior recommendations for population-based screening have recently been withdrawn (30). A strategy to treat all cases of Barrett's esophagus (31) without accurate risk stratification would be cost prohibitive, expose low-or no-risk patients to harm from serious adverse events (including esophageal perforation and stricture; ref. 30), and have a negligible impact on the mortality of esophageal adenocarcinoma (26)(27)(28).…”