RF ablation proves its worth in Barrett’s esophagus

An endoscopically guided radiofrequency ablation device proved safe and effective for the treatment of Barrett's esophagus, according to a multicenter study led by Mayo Clinic researchers. Managing the condition with RFA could keep many patients from developing potentially lethal esophageal malignancies.

Dr. Virender K. Sharma and colleagues at eight U.S. institutions used an endoscopic device that measures inner esophageal diameter and delivers RF energy with a special balloon fitted in one end. The investigators assessed the device's energy dose safety on one group of 32 patients with Barrett's esophagus. They subsequently evaluated its effectiveness on a different group of 70 patients diagnosed with the condition.

The researchers found no serious complications at three months follow-up of the first group, and they were able to determine the appropriate energy dose (10 J/cm²) for the next leg of the study. They achieved a 70% treatment success rate with the second group of patients at one year follow-up.

Biopsy confirmed that the circumferential ablation injury provided by the device produced no subsequent strictures or permanent damage to mucous glands (Gastrointest Endosc 2007;65[2]:185-195).

About 10% of patients who suffer from heartburn develop Barrett's esophagus. Researchers believe that the chronic acid exposure from reflux causes an abnormal change in the cells lining the lower end of the esophagus. The condition is associated with an increased risk of esophageal cancer.

"Most patients who get invasive esophageal cancer will die. It's one of the more lethal cancers. But in its precancerous phase, or the high-grade dysplasia phase, it's highly treatable, and we think curable," said Dr. Herbert Wolfsen, a gastroenterologist at the Mayo Clinic in Jacksonville, FL, who has also tried the procedure.

The current standard of care involves monitoring the course of the condition with endoscopy. The new treatment represents an option for patients who feel uneasy with this approach, Wolfsen said.

There is no conclusive data to show that patients who undergo RFA for Barrett's esophagus or low-grade dysplasia will never develop cancer. The risk, however, should be significantly lower if this treatment proves as effective as photodynamic therapy, another minimally invasive procedure used in patients with high-grade dysplasia.

Wolfsen and colleagues are enrolling patients with low-grade dysplasia and Barrett's esophagus in a multicenter trial to further establish the procedure's effectiveness.

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