Radiofrequency Ablation in Barrett's Esophagus with Dysplasia

Abstract

In patients with dysplastic Barrett's esophagus, radiofrequency ablation was associated with a high rate of complete eradication of both dysplasia and intestinal metaplasia and a reduced risk of disease progression. (ClinicalTrials.gov number, NCT00282672.)

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.…”

“…Studies to date, including the landmark randomized controlled trial of Shaheen et al (ablation of intestinal metaplasia [AIM] dysplasia trial), demonstrate a clear benefit for RFA in the treatment of high-grade dysplasia, ideally with endoscopic mucosal resection of any mucosal abnormalities prior to application [5,8]. In addition, preliminary results of a randomized controlled clinical trial of circumferential endoscopic mucosal resection versus focal endoscopic mucosal resection plus RFA for highgrade dysplasia and early adenocarcinoma suggest that the two techniques are comparable for the important endpoints of elimination of neoplasia and intestinal neoplasia, but the complication rate for endoscopic mucosal resection plus RFA is substantially lower [9].…”

“…Factors associated with progression to cancer include a consensus agreement among two or more pathologists and the extent of low-grade dysplasia [13,14]. In the AIM dysplasia study, the 64 patients with low-grade dysplasia had their diagnosis confirmed by a central pathology reading at the Cleveland Clinic prior to entry into the study [5]. By intention-to-treat analysis, complete eradication of low-grade dysplasia was accomplished in 90%, complete elimination of intestinal metaplasia was accomplished in 81%, and progression to high-grade dysplasia occurred in 5% at 12 months.…”

Blinding in trials of interventional procedures is possible and worthwhile

“…For example, a study by Hrobjartsson and colleagues demonstrated that non-blinded assessors were over-optimistic and “over-rated” patients in the treatment group rather than “under-rated” patients in the control group 20 . In some trials the assessment was done by people not involved in the surgery, for example blinded researchers, staff at another hospital that they were operated on at 21 , or by pathologist blinded to the treatment allocation 22 .…”

Fiberoptic Endoscopy: The Singular Transformative Event of Our Time

“…Endoscopic ablative technologies including laser or radiofrequency ablation can remove high-grade dysplasia or early cancer that was at one time only amenable to surgical treatment [18,19]. Endosocpically deployed stents for obstructing upper and lower GI cancers achieve good palliation while avoiding the potential mortality of surgical bypass.…”