Preliminary Experience with Radiofrequency Ablation of Barrett’s Esophagus with in situ Dysplasia or Carcinoma
DOI:
https://doi.org/10.22516/25007440.433Keywords:
Barrett’s esophagus, esophageal cancer, esophageal dysplasia, metaplasia, in situ carcinoma, radiofrequency ablationAbstract
Introduction: Barrett’s esophagus (BE) is the result of chronic damage to the esophageal epithelium caused by the acid of gastrointestinal reflux diseases (GERD). It is defined as replacement of the by stratified squamous epithelium that normally lines the esophagus with metaplastic columnar epithelium. BE represents a risk factor for esophageal adenocarcinoma. The aim of radiofrequency ablation (RFA) is to destroy the metaplastic epithelium with the electric current of a radiofrequency to stimulate the reappearance of stratified squamous epithelium in the distal esophagus.
Objective: The objective of this study was to evaluate the efficiency and safety of RFA which has recently been introduced in the city of Medellin, Colombia for management of BE with in situ dysplasia or carcinoma.
Materials and Methods: Ten patients were treated with RFA. BE patients with in situ dysplasia or carcinoma and histological diagnoses were chosen for treatment. RFA procedures were done with BARRX equipment, the circular HALO360 system or the HALO90 system. Macroscopic and microscopic effects of RFA, patient tolerance to treatment and complications were evaluated.
Results: A group of 10 patients received treatment with RFA. All ten finished treatment and follow-up. Seven patients had low-grade dysplasia, two had high-grade dysplasia, and one patient had in situ carcinoma. Two patients had undergone endoscopic resections of nodules and treatments of mucosa with bands prior to therapy with RFA. A total of 13 procedures were performed: 10 RFAs with the HALO360, 2 RFAs with the HALO90 and one argon plasma treatment for residual BE in one patient. Eradication of metaplastic and dysplastic esophageal epithelium was achieved in all patients and confirmed by endoscopic and histologic evaluation. No significant complications related to RFA were found, but in two patients esophageal stenoses were found. One required endoscopic dilatation three weeks after therapy.
Conclusions: Based on these preliminary results we believe that this is a promising method that is well-tolerated by patients and which has no major complications. Metaplastic and dysplastic epithelium of the distal esophagus were successfully eradicated in most patients.
Downloads
References
de Jonge PJ, van Blankenstein M, Grady WM, Kuipers EJ. Barrett’s oesophagus: epidemiology, cancer risk and implications for management. Gut 2014; 63: 191-202.
Fitzgerald RC, di Pietro M, Ragunath K, et al. British Society of Gastroenterology guidelines on the diagnosis and management of Barrett’s oesophagus. Gut 2014; 63: 7-42.
Spechler SJ, Sharma P, Souza RF, Inadomi JM, Shaheen NJ, American Gastroenterological A. American Gastroenterological Association technical review on the management of Barrett’s esophagus. Gastroenterology 2011; 140: e18-52; quiz e13.
Zhang Y. Epidemiology of esophageal cancer. World journal of gastroenterology : WJG 2013; 19: 5598-606.
Sie C, Bright T, Schoeman M, et al. Argon plasma coagulation ablation versus endoscopic surveillance of Barrett’s esophagus: late outcomes from two randomized trials. Endoscopy 2013; 45: 859-65.
Anders M, Bahr C, El-Masry MA, et al. Long-term recurrence of neoplasia and Barrett’s epithelium after complete endoscopic resection. Gut 2014.
Barret M, Pratico CA, Beuvon F, et al. Esophageal circumferential en bloc endoscopic submucosal dissection: assessment of a new technique. Surgical laparoscopy, endoscopy & percutaneous techniques 2013; 23: e182-7.
Gosain S, Mercer K, Twaddell WS, Uradomo L, Greenwald BD. Liquid nitrogen spray cryotherapy in Barrett’s esophagus with high-grade dysplasia: long-term results. Gastrointestinal endoscopy 2013; 78: 260-5.
Gray J, Fullarton GM. Long term efficacy of Photodynamic Therapy (PDT) as an ablative therapy of high grade dysplasia in Barrett’s oesophagus. Photodiagnosis and photodynamic therapy 2013; 10: 561-5.
Ertan A, Zaheer I, Correa AM, Thosani N, Blackmon SH. Photodynamic therapy vs radiofrequency ablation for Barrett’s dysplasia: Efficacy, safety and cost-comparison. World journal of gastroenterology: WJG 2013; 19: 7106-13.
Rey-Ferro M, Pinilla RE. Erradicación total de esófago de Barrett con displasia de bajo y alto grado por medio de terapia combinada con resección mucosa focal con Duette y ablación por radiofrecuencia: Reporte de caso y revisión de la literatura. Rev Col Gastroenterol 2013; 28: 124-32.
Bulsiewicz WJ, Shaheen NJ. The role of radiofrequency ablation in the management of Barrett’s esophagus. Gastrointestinal endoscopy clinics of North America 2011; 21: 95-109.
Shaheen NJ, Sharma P, Overholt BF, et al. Radiofrequency ablation in Barrett’s esophagus with dysplasia. The New England journal of medicine 2009; 360: 2277-88.
Shaheen NJ, Overholt BF, Sampliner RE, et al. Durability of radiofrequency ablation in Barrett’s esophagus with dysplasia. Gastroenterology 2011; 141: 460-8.
Phoa KN, Pouw RE, van Vilsteren FG, et al. Remission of Barrett’s esophagus with early neoplasia 5 years after radiofrequency ablation with endoscopic resection: a Netherlands cohort study. Gastroenterology 2013; 145: 96-104.
Orman ES, Kim HP, Bulsiewicz WJ, et al. Intestinal metaplasia recurs infrequently in patients successfully treated for Barrett’s esophagus with radiofrequency ablation. The American journal of gastroenterology 2013; 108: 187-95; quiz 96.
Orman ES, Li N, Shaheen NJ. Efficacy and durability of radiofrequency ablation for Barrett’s Esophagus: systematic review and meta-analysis. Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association 2013; 11: 1245-55.
Pouw RE, Gondrie JJ, Rygiel AM, et al. Properties of the neosquamous epithelium after radiofrequency ablation of Barrett’s esophagus containing neoplasia. The American journal of gastroenterology 2009; 104: 1366-73.
Anand O, Wani S, Sharma P. When and how to grade Barrett’s columnar metaplasia: the Prague system. Best practice & research Clinical gastroenterology 2008; 22: 661-9.
Smith CD, Bejarano PA, Melvin WS, Patti MG, Muthusamy R, Dunkin BJ. Endoscopic ablation of intestinal metaplasia containing high-grade dysplasia in esophagectomy patients using a balloon-based ablation system. Surgical endoscopy 2007; 21: 560-9.
Dunkin BJ, Martinez J, Bejarano PA, et al. Thin-layer ablation of human esophageal epithelium using a bipolar radiofrequency balloon device. Surgical endoscopy 2006; 20: 125-30.
Pouw RE, Sharma VK, Bergman JJ, Fleischer DE. Radiofrequency ablation for total Barrett’s eradication: a description of the endoscopic technique, its clinical results and future prospects. Endoscopy 2008; 40: 1033-40.
Chadwick G, Groene O, Markar SR, Hoare J, Cromwell D, Hanna GB. Systematic review comparing radiofrequency ablation and complete endoscopic resection in treating dysplastic Barrett’s esophagus: a critical assessment of histologic outcomes and adverse events. Gastrointestinal endoscopy 2014.
Singh M, Gupta N, Gaddam S, et al. Practice patterns among U.S. gastroenterologists regarding endoscopic management of Barrett’s esophagus. Gastrointestinal endoscopy 2013;78:689-95.
Fleisher LA. Improving perioperative outcomes: my journey into risk, patient preferences, guidelines, and performance measures: Ninth Honorary FAER Research Lecture. Anesthesiology 2010; 112: 794-801.
Qumseya BJ, Wang H, Badie N, et al. Advanced imaging technologies increase detection of dysplasia and neoplasia in patients with Barrett’s esophagus: a meta-analysis and systematic review. Clinical gastroenterology and hepatology: the official clinical practice journal of the American Gastroenterological Association 2013; 11: 1562-70 e1-2.
Gaddam S, Wani S. Endoscopic therapy of Barrett esophagus. Gastrointestinal endoscopy clinics of North America 2013; 23: 1-16.
Wu J, Pan YM, Wang TT, Gao DJ, Hu B. Endotherapy versus surgery for early neoplasia in Barrett’s esophagus: a meta-analysis. Gastrointestinal endoscopy 2013.
Lyday WD, Corbett FS, Kuperman DA, et al. Radiofrequency ablation of Barrett’s esophagus: outcomes of 429 patients from a multicenter community practice registry. Endoscopy 2010; 42: 272-8.
Ganz RA, Overholt BF, Sharma VK, et al. Circumferential ablation of Barrett’s esophagus that contains high-grade dysplasia: a U.S. Multicenter Registry. Gastrointestinal endoscopy 2008; 68: 35-40.
Sharma VK, Wang KK, Overholt BF, et al. Balloon-based, circumferential, endoscopic radiofrequency ablation of Barrett’s esophagus: 1-year follow-up of 100 patients. Gastrointestinal endoscopy 2007; 65: 185-95.
Fleischer DE, Overholt BF, Sharma VK, et al. Endoscopic ablation of Barrett’s esophagus: a multicenter study with 2.5-year follow-up. Gastrointestinal endoscopy 2008; 68: 867-76.
Yoon SS, Rivera R, Antignano L, Kaul V. A case of mediastinitis after radiofrequency ablation for Barrett’s esophagus. Gastrointestinal endoscopy 2011; 74: 1407-8.
Vahabzadeh B, Rastogi A, Bansal A, Sharma P. Use of a plastic endoprosthesis to successfully treat esophageal perforation following radiofrequency ablation of Barrett’s esophagus. Endoscopy 2011; 43: 67-9.
Chennat J, Konda VJ, Ross AS, et al. Complete Barrett’s eradication endoscopic mucosal resection: an effective treatment modality for high-grade dysplasia and intramucosal carcinoma--an American single-center experience. The American journal of gastroenterology 2009; 104: 2684-92.
Dabrowski WP, Szczepanik AB, Misiak A, Pielacinski K. Radiofrequency ablation in the management of Barrett’s esophagus - preliminary own experience. Wideochirurgia i inne techniki malo inwazyjne = Videosurgery and other miniinvasive techniques / kwartalnik pod patronatem Sekcji Wideochirurgii TChP oraz Sekcji Chirurgii Bariatrycznej TChP 2013; 8: 107-11.
van Vilsteren FG, Alvarez Herrero L, Pouw RE, et al. Radiofrequency ablation and endoscopic resection in a single session for Barrett’s esophagus containing early neoplasia: a feasibility study. Endoscopy 2012; 44: 1096-104.
Das A, Wells C, Kim HJ, Fleischer DE, Crowell MD, Sharma VK. An economic analysis of endoscopic ablative therapy for management of nondysplastic Barrett’s esophagus. Endoscopy 2009; 41: 400-8.
Inadomi JM, Somsouk M, Madanick RD, Thomas JP, Shaheen NJ. A cost-utility analysis of ablative therapy for Barrett’s esophagus. Gastroenterology 2009; 136: 2101-14 e1-6.
Hur C, Choi SE, Rubenstein JH, et al. The cost effectiveness of radiofrequency ablation for Barrett’s esophagus. Gastroenterology 2012; 143: 567-75.
Fitzgerald RC, di Pietro M, Ragunath K, et al. British Society of Gastroenterology guidelines on the diagnosis and management of Barrett’s oesophagus. Gut 2014; 63: 7-42.
Fudman DI, Lightdale CJ, Poneros JM, et al. Positive correlation between endoscopist radiofrequency ablation volume and response rates in Barrett’s esophagus. Gastrointestinal endoscopy 2014.
Phoa KN, van Vilsteren FG, Weusten BL, et al. Radiofrequency ablation vs endoscopic surveillance for patients with Barrett esophagus and low-grade dysplasia: a randomized clinical trial. JAMA: the journal of the American Medical Association 2014; 311: 1209-17.
Downloads
Published
How to Cite
Issue
Section
License
Aquellos autores/as que tengan publicaciones con esta revista, aceptan los términos siguientes:
Los autores/as ceden sus derechos de autor y garantizarán a la revista el derecho de primera publicación de su obra, el cuál estará simultáneamente sujeto a la Licencia de reconocimiento de Creative Commons que permite a terceros compartir la obra siempre que se indique su autor y su primera publicación en esta revista.
Los contenidos están protegidos bajo una licencia de Creative Commons Reconocimiento-NoComercial-SinObraDerivada 4.0 Internacional.
| Article metrics | |
|---|---|
| Abstract views | |
| Galley vies | |
| PDF Views | |
| HTML views | |
| Other views | |
