, Volume 56, Issue 7, pp 1926-1928
Date: 21 Apr 2011

Barrett’s Esophagus Without Dysplasia: Wait or Ablate?

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In Barrett’s esophagus, metaplastic columnar epithelium that is predisposed to malignancy replaces the stratified squamous epithelium that normally lines the distal esophagus [1]. Barrett’s metaplasia develops as a result of chronic esophageal inflammation caused by the gastroesophageal reflux of noxious material like acid and bile. Endoscopic ablation of this metaplasia has been proposed as a way to prevent cancer. Recent attention has focused on radiofrequency ablation (RFA), which uses endoscopic guidance to position a balloon with a circumferential array of electrodes (the HALO360 ablation balloon) to deliver radiofrequency energy to the metaplastic esophageal epithelium. Patients are treated with proton pump inhibitors (PPIs) to control acid reflux, and the ablated columnar epithelium heals with the growth of new (neo)squamous epithelium. In 30–46% of patients, treatment with the HALO360 balloon leaves behind visible foci of Barrett’s metaplasia, which can be eradicated with a sma