Thin-layer ablation of human esophageal epithelium using a bipolar radiofrequency balloon device
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The goal of this study was to determine the optimal treatment parameters for the ablation of human esophageal epithelium using a balloon-based bipolar radiofrequency (RF) energy electrode.
Immediately prior to esophagectomy, subjects underwent esophagoscopy and ablation of two separate, 3-cm long, circumferential segments of non-tumor-bearing esophageal epithelium using a balloon-based bipolar RF energy electrode (BARRX Medical, Inc., Sunnyvale, CA, USA). Subjects were randomized to one of three energy density groups: 8, 10, or 12 J/cm2. RF energy was applied one time (1×) proximally and two times (2×) distally. Following resection, sections from each ablation zone were evaluated using H&E and diaphorase. Histological endpoints were complete epithelial ablation (yes/no), maximum ablation depth, and residual ablation thickness after tissue slough. Outcomes were compared according to energy density group and 1× vs 2× treatment.
Thirteen male subjects (age, 49–85 years) with esophageal adenocarcinoma underwent the ablation procedure followed by total esophagectomy. Complete epithelial removal occurred in the following zones: 10 J/cm2 (2×) and 12 J/cm2 (1× and 2×). The maximum depth of injury was the muscularis mucosae: 10 and 12 J/cm2 (both 2×). A second treatment (2×) did not significantly increase the depth of injury. Maximum thickness of residual ablation after tissue slough was only 35 μm.
Complete removal of the esophageal epithelium without injury to the submucosa or muscularis propria is possible using this balloon-based RF electrode at 10 J/cm2 (2×) or 12 J/cm2 (1× or 2×). A second application (2×) does not significantly increase ablation depth. These data have been used to select the appropriate settings for treating intestinal metaplasia in trials currently under way.
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- Thin-layer ablation of human esophageal epithelium using a bipolar radiofrequency balloon device
Surgical Endoscopy And Other Interventional Techniques
Volume 20, Issue 1 , pp 125-130
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- Intestinal metaplasia
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- 1. University of Miami School of Medicine, 1475 NW 12th Avenue, Suite 4023, Miami, FL, 33136, USA
- 2. Department of Surgery, Emory University School of Medicine, 1364 Clifton Road, NE, Suite H-122, Atlanta, GA, 30322, USA
- 3. Comprehensive Digestive Disease Center, University of California, Irvine, 101 The City Drive, Building 22C, First Floor, Orange, CA, 92868, USA
- 4. Center for Minimally Invasive Surgery, The Ohio State University, Room N729 Doan Hall, 410 West Tenth Avenue, Columbus, OH, 43210, USA