Surgical Endoscopy

, Volume 24, Issue 12, pp 2935–2943 | Cite as

A systematic review of the evidence for radiofrequency ablation for Barrett’s esophagus

  • Thomas Semlitsch
  • Klaus Jeitler
  • Rainer Schoefl
  • Karl Horvath
  • Nicole Pignitter
  • Franz Harnoncourt
  • Andrea Siebenhofer



Radiofrequency ablation with the HALO system is a new option for the treatment of patients with Barrett’s esophagus. This systematic review summarizes the results of all relevant publications on this topic to answer patient-relevant clinical questions and to evaluate the potential benefit and harm of this new therapy.


A systematic literature search of MEDLINE and CENTRAL up to May 2009 was performed. To identify the relevant literature, references were evaluated by two reviewers independently. The inclusion criteria for the review required that studies investigated patients with Barrett’s esophagus, used radiofrequency ablation as the intervention, and had a minimum follow-up period of 12 months.


A total of nine relevant observational studies (involving 429 patients) were identified. Complete eradication of Barrett’s esophagus dysplasia and metaplasia was achieved respectively for 71–100% and for 46–100% of the patients. Only six cases of stenosis and one case of buried intestinal metaplasia were reported among all the patients. Only a few mild adverse events were reported.


Based on the evidence of observational studies, the summary of the current data suggests that radiofrequency ablation with the HALO system could be a promising method associated with a low complication rate, low risk of stricture formations, and a minor probability of buried glands. To evaluate the potential benefit at a higher level of evidence, randomized controlled trials (RCTs) involving a direct comparison with other more established endoscopic methods such as photodynamic therapy are necessary.


Barrett’s esophagus Radiofrequency ablation Systematic review 



We thank Ursula Püringer and Eva Matyas for their assistance in reviewing and collecting the data and Eugenie Lamont for helping to prepare the manuscript.


This review was for the most part commissioned by and conducted in collaboration with the Elisabethinen Hospital Linz. Thomas Semlitsch, Klaus Jeitler, Karl Horvath, Nicole Pignitter from the Evidence Based Medicine Review Center of the Medical University of Graz and Andrea Siebenhofer from the Goethe University, Frankfurt am Main were paid by the Elisabethinen Hospital Linz. Rainer Schoefl and Franz Harnoncourt are employees of the Elisabethinen Hospital Linz. Thomas Semlitsch, Klaus Jeitler, Karl Horvath, Nicole Pignitter, Andrea Siebenhofer, Rainer Schoefl, and Franz Harnoncourt have no conflicts of interest or financial ties to disclose.


  1. 1.
    Ronkainen J, Aro P, Storskrubb T, Johansson SE, Lind T, Bolling-Sternevald E, Vieth M, Stolte M, Talley NJ, Agreus L (2005) Prevalence of Barrett’s esophagus in the general population: an endoscopic study. Gastroenterology 129:1825–1831CrossRefPubMedGoogle Scholar
  2. 2.
    Byrne JP, Mathers JM, Parry JM, Attwood SE, Bancewicz J, Woodman CB (2002) Site distribution of oesophagogastric cancer. J Clin Pathol 55:191–194PubMedGoogle Scholar
  3. 3.
    Jankowski JA, Provenzale D, Moayyedi P (2002) Esophageal adenocarcinoma arising from Barrett’s metaplasia has regional variations in the west. Gastroenterology 122:588–590CrossRefPubMedGoogle Scholar
  4. 4.
    Koop H, Schepp W, Muller-Lissner S, Madisch A, Micklefield G, Messmann H, Fuchs KH, Hotz J (2005) Consensus conference of the DGVS on gastroesophageal reflux. Z Gastroenterol 43:163–164CrossRefPubMedGoogle Scholar
  5. 5.
    British Society of Gastroenterology (BSG) (2005) Guidelines for the diagnosis and management of Barrett’s columnar-lined oesophagus. Retrieved 12 May 2009
  6. 6.
    Wang KK, Sampliner RE (2008) Updated guidelines 2008 for the diagnosis, surveillance, and therapy of Barrett’s esophagus. Am J Gastroenterol 103:788–797CrossRefPubMedGoogle Scholar
  7. 7.
    Pouw RE, Gondrie JJ, Curvers WL, Sondermeijer CM, ten Kate FJ, Bergman JJ (2008) Successful balloon-based radiofrequency ablation of a widespread early squamous cell carcinoma and high-grade dysplasia of the esophagus: a case report. Gastrointest Endosc 68:537–541CrossRefPubMedGoogle Scholar
  8. 8.
    Hubbard N, Velanovich V (2007) Endoscopic endoluminal radiofrequency ablation of Barrett’s esophagus in patients with fundoplications. Surg Endosc 21:625–628CrossRefPubMedGoogle Scholar
  9. 9.
    Gondrie JJ, Pouw RE, Sondermeijer CM, Peters FP, Curvers WL, Rosmolen WD, Krishnadath KK, Ten KF, Fockens P, Bergman JJ (2008) Stepwise circumferential and focal ablation of Barrett’s esophagus with high-grade dysplasia: results of the first prospective series of 11 patients. Endoscopy 40:359–369CrossRefPubMedGoogle Scholar
  10. 10.
    Gondrie JJ, Pouw RE, Sondermeijer CM, Peters FP, Curvers WL, Rosmolen WD, Ten KF, Fockens P, Bergman JJ (2008) Effective treatment of early Barrett’s neoplasia with stepwise circumferential and focal ablation using the HALO system. Endoscopy 40:370–379CrossRefPubMedGoogle Scholar
  11. 11.
    Hernandez JC, Reicher S, Chung D, Pham BV, Tsai F, Disibio G, French S, Eysselein VE (2008) Pilot series of radiofrequency ablation of Barrett’s esophagus with or without neoplasia. Endoscopy 40:388–392CrossRefPubMedGoogle Scholar
  12. 12.
    Sharma VK, Kim HJ, Das A, Dean P, DePetris G, Fleischer DE (2008) A prospective pilot trial of ablation of Barrett’s esophagus with low-grade dysplasia using stepwise circumferential and focal ablation (HALO system). Endoscopy 40:380–387CrossRefPubMedGoogle Scholar
  13. 13.
    Rosch T (2008) BARRx for total Barrett’s eradication: the new super weapon? Endoscopy 40:393–394CrossRefPubMedGoogle Scholar
  14. 14.
    Overholt BF, Panjehpour M, Halberg DL (2003) Photodynamic therapy for Barrett’s esophagus with dysplasia and/or early stage carcinoma: long-term results. Gastrointest Endosc 58:183–188CrossRefPubMedGoogle Scholar
  15. 15.
    Peters F, Kara M, Rosmolen W, Aalders M, Ten Kate F, Krishnadath K, van Lanschot J, Fockens P, Bergman J (2005) Poor results of 5-aminolevulinic acid-photodynamic therapy for residual high-grade dysplasia and early cancer in Barrett’s esophagus after endoscopic resection. Endoscopy 37:418–424CrossRefPubMedGoogle Scholar
  16. 16.
    Van Laethem JL, Jagodzinski R, Peny MO, Cremer M, Deviere J (2001) Argon plasma coagulation in the treatment of Barrett’s high-grade dysplasia and in situ adenocarcinoma. Endoscopy 33:257–261CrossRefPubMedGoogle Scholar
  17. 17.
    Beaumont H, Gondrie JJ, McMahon BP, Pouw RE, Gregersen H, Bergman JJ, Boeckxstaens GE (2009) Stepwise radiofrequency ablation of Barrett’s esophagus preserves esophageal inner diameter, compliance, and motility. Endoscopy 41:2–8CrossRefPubMedGoogle Scholar
  18. 18.
    Ganz RA, Overholt BF, Sharma VK, Fleischer DE, Shaheen NJ, Lightdale CJ, Freeman SR, Pruitt RE, Urayama SM, Gress F, Pavey DA, Branch MS, Savides TJ, Chang KJ, Muthusamy VR, Bohorfoush AG, Pace SC, DeMeester SR, Eysselein VE, Panjehpour M, Triadafilopoulos G, USM Registry (2008) Circumferential ablation of Barrett’s esophagus that contains high-grade dysplasia: a U.S. Multicenter Registry (see comment). Gastrointest Endosc 68:35–40CrossRefPubMedGoogle Scholar
  19. 19.
    Sharma VK, Jae Kim H, Das A, Wells CD, Nguyen CC, Fleischer DE (2009) Circumferential and focal ablation of Barrett’s esophagus containing dysplasia. Am J Gastroenterol 104:310–317CrossRefPubMedGoogle Scholar
  20. 20.
    Roorda AK, Marcus SN, Triadafilopoulos G (2007) Early experience with radiofrequency energy ablation therapy for Barrett’s esophagus with and without dysplasia. Dis Esophagus 20:516–522CrossRefPubMedGoogle Scholar
  21. 21.
    Velanovich V (2009) Endoscopic endoluminal radiofrequency ablation of Barrett’s esophagus: initial results and lessons learned. Surg Endosc 23(10):2175–2180CrossRefPubMedGoogle Scholar
  22. 22.
    Fleischer DE, Overholt BF, Sharma VK, Reymunde A, Kimmey MB, Chuttani R, Chang KJ, Lightdale CJ, Santiago N, Pleskow DK, Dean PJ, Wang KK (2008) Endoscopic ablation of Barrett’s esophagus: a multicenter study with 2.5-year follow-up. Gastrointest Endosc 68:867–876CrossRefPubMedGoogle Scholar
  23. 23.
    Sharma VK, Wang KK, Overholt BF, Lightdale CJ, Fennerty MB, Dean PJ, Pleskow DK, Chuttani R, Reymunde A, Santiago N, Chang KJ, Kimmey MB, Fleischer DE (2007) Balloon-based, circumferential, endoscopic radiofrequency ablation of Barrett’s esophagus: 1-year follow-up of 100 patients (see comment). Gastrointest Endosc 65:185–195CrossRefPubMedGoogle Scholar
  24. 24.
    ICH—International Conference of Harmonization (1996, May) E6(R1)—Good clinical practice: consolidated guideline. Retrieved 18 May 2009
  25. 25.
    Barr H, Stone N, Rembacken B (2005) Endoscopic therapy for Barrett’s oesophagus. Gut 54:875–884CrossRefPubMedGoogle Scholar
  26. 26.
    Li YM, Li L, Yu CH, Liu YS, Xu CF (2008) A systematic review and meta-analysis of the treatment for Barrett’s esophagus. Dig Dis Sci 53:2837–2846CrossRefPubMedGoogle Scholar
  27. 27.
    Bumgarner J, Panjehpour M, Long MD, Dellon ES, Madanick RD, Overholt BF, Shaheen NJ (2008) Comparison of catheter-based radiofrequency ablation and photodynamic therapy for Barrett’s esophagus. Digestive Disease Week, San Diego, CA, USAGoogle Scholar
  28. 28.
    Shaheen NJ, Sharma P, Overholt BF, Wolfsen HC, Sampliner RE, Wang KK, Galanko JA, Bronner MP, Goldblum JR, Bennett AE, Jobe BA, Eisen GM, Fennerty MB, Hunter JG, Fleischer DE, Sharma VK, Hawes RH, Hoffman BJ, Rothstein RI, Gordon SR, Mashimo H, Chang KJ, Muthusamy VR, Edmundowicz SA, Spechler SJ, Siddiqui AA, Souza RF, Infantolino A, Falk GW, Kimmey MB, Madanick RD, Chak A, Lightdale CJ (2009) Radiofrequency ablation in Barrett’s esophagus with dysplasia. N Engl J Med 360:2277–2288CrossRefPubMedGoogle Scholar
  29. 29.
    Shaheen NJ, Wolfsen HC, Hawes RH, Rothstein RI, Spechler SJ, Galanko J, Bright SD, Infantolio A, Siddiqui A (2008) Impact of Barrett’s esophagus containing dysplasia on patient quality of life: interim results of a randomized, sham-controlled trial of radiofrequency ablation (AIM Dysplasia Trial). Digestive Disease Week, San Diego, California, USAGoogle Scholar
  30. 30.
    Pouw RE, Wirths K, Eisendrath P, Sondermeijer CM, Ten Kate FJ, Fockens P, Deviere J, Neuhaus H, Bergman JJ (2009) Efficacy of radiofrequency ablation combined with endoscopic resection for Barrett’s esophagus with early neoplasia. Clin Gastroenterol Hepatol 8:23–29, S1542-3565(09)00662-4 [PII]. doi: 10.1016/j.cgh.2009.07.003. Accessed 16 July 2009Google Scholar
  31. 31.
    Pouw RE, Gondrie JJ, Van Vilsteren FG, Sondermeijer CM, Herrero LA, Kate FJ, Krishnadath K, Fockens P, Weusten BL, Bergman J (2008) Complications following primary circumferential radiofrequency ablation of Barrett’s esophagus with early neoplasia. Digestive Disease Week, San Diego, CA, USAGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2010

Authors and Affiliations

  • Thomas Semlitsch
    • 1
  • Klaus Jeitler
    • 1
    • 2
  • Rainer Schoefl
    • 3
  • Karl Horvath
    • 1
  • Nicole Pignitter
    • 1
  • Franz Harnoncourt
    • 3
  • Andrea Siebenhofer
    • 4
  1. 1.Department of Internal Medicine, Evidence Based Medicine Review CenterMedical University of GrazGrazAustria
  2. 2.Institute for Medical Informatics, Statistics and DocumentationMedical University of GrazGrazAustria
  3. 3.Department of Gastroenterology, Hepatology, Metabolism, and NutritionElisabethinen HospitalLinzAustria
  4. 4.Institute for General PracticeGoethe UniversityFrankfurt am MainGermany

Personalised recommendations