Emerging indications of endoscopic radiofrequency ablation

Abstract

Introduction: Radiofrequency ablation (RFA) is a well-validated treatment of dysplastic Barrett's esophagus. Other indications of endoscopic RFA are under evaluation. Results: Four prospective studies (total 69 patients) have shown that RFA achieved complete remission of early esophageal squamous intra-epithelial neoplasia at a rate of 80%, but with a substantial risk of stricture. In the setting of gastric antral vascular ectasia, two prospective monocenter studies, and a retrospective multicenter study, (total 51 patients), suggest that RFA is efficacious in terms of reducing transfusion dependency. In the setting of chronic hemorrhagic radiation proctopathy, a prospective monocenter study and a retrospective multicenter study (total 56 patients) suggest that RFA is an efficient treatment. A retrospective comparative study (64 patients) suggests that RFA improves stents patency in malignant biliary strictures. Conclusions: Endoscopic RFA is an upcoming treatment modality in early esophageal squamous intra-epithelial neoplasia, as well as in gastric, rectal, and biliary diseases.

Feasibility of liquid nitrogen cryotherapy after failed radiofrequency ablation for Barrett's esophagus

“…RFA failures may occur as a result of increased mucosal thickness that can result in decreased ablation effect. RFA allows for ablation down to the level of the lamina propria when successful . This ablation is more superficial when the mucosa is thicker.…”

“…Cryotherapy achieves mucosal ablation with cryo‐necrosis occurring up to the level of the submucosa or deeper . Given this deeper level of ablation with cryotherapy versus RFA (ablation to the lamina propria), it may be preferable to use cryotherapy after RFA failure. We report our experience on the use of LNC for RFA failures at two large tertiary care medical centers with a rich experience in all treatment modalities of BE treatment.…”

Insights into the management of gastric antral vascular ectasia (watermelon stomach)

“…The minimal time interval of 6 weeks between each treatment session is recommended and proton pump inhibitors should be prescribed. 61 RFA is a well-tolerated and feasible method for patients with GAVE with poor response to APC and band ligation.…”

Radiofrequency ablation is a treatment option for early stages of verrucous esophageal carcinoma

“…Given that the mucosa was affected only superficially (500 μm), radiofrequency ablation (RFA), with a known penetration depth of 800 μm to 1000 μm, seemed to be a promising option. 2 Within an interval of 3 months, 2 consecutive RFA sessions ( Fig. 6 and Video 1 , available online at www.VideoGIE.org ) were performed by use of the Barrx 90 and the Barrx 60 RFA Focal Catheter (Covidien, Mansfield, Mass).…”