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European Surgery

, Volume 47, Issue 6, pp 319–323 | Cite as

Austrian expert panel recommendation for radiofrequency ablation of Barrett’s esophagus

  • I. Kristo
  • S.F. SchoppmannEmail author
  • M. Riegler
  • A. Püspök
  • K. Emmanuel
  • G. Spaun
  • F. Wrba
  • E. Wenzl
  • R. Schöfl
  • F. Schreiber
  • M. Häfner
  • C. Madl
Original Article

Summary

Background

Barrett’s esophagus (BE) represents the premalignant manifestation of gastroesophageal reflux disease and includes columnar lined esophagus with intestinal metaplasia, low-grade dysplasia, high-grade dysplasia and cancer.

Methods

An Austrian panel of expert meeting was held at the Medical University Vienna, June 2015, to establish and define recommendations for the endoscopic treatment of BE with and without dysplasia and cancer. Recommendations are based on critical analysis of published evidence. Statistics were not applied.

Results

Diagnosis of cancer and dysplasia is to be reconfirmed by a second expert pathologist. Advanced cancer (> T1a) requires surgical resection ± adjuvant therapies. Treatment of T1a early cancer, high- and low-grade dysplasia should include endoscopic mucosal resection (EMR) and radiofrequency ablation (RFA). In the presence of increased cancer risk, BE without dysplasia should be treated by RFA within clinical studies only. Elimination of any early cancer, dysplasia and IM defines complete response, that is, post RFA histopathology shows squamous, cardiac or oxyntocardiac mucosa lined esophagus (Chandrasoma classification). Follow-up endoscopies are timed according to the base line histopathology. Down grade from cancer to dysplasia or from dysplasia to non-dysplastic BE defines partial response, respectively. Based on esophageal function testing, reflux is treated by medical or surgical therapy.

Conclusion

In Austria, RFA ± EMR is recommended for BE containing early cancer or dysplasia. Non-dysplastic BE with an increased cancer risk should be offered RFA within clinical trials to assess the efficacy for cancer prevention in this group of patients.

Keywords

Barrett’s esophagus Dysplasia Esophageal cancer Radiofrequency ablation 

Notes

Acknowledgments

The authors thank their patients for giving them the opportunity to learn about Barrett’s esophagus diagnosis and treatment. In addition, the authors express their gratitude to their supportive teachers, families and friends. May the open-minded approach continue to foster the development of future diagnosis and therapy of Barrett’s esophagus.

Conflict of interest

The authors declare that there are no actual or potential conflicts of interest in relation to this article.

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Copyright information

© Springer-Verlag Wien 2015

Authors and Affiliations

  • I. Kristo
    • 1
  • S.F. Schoppmann
    • 1
    Email author
  • M. Riegler
    • 1
  • A. Püspök
    • 2
  • K. Emmanuel
    • 3
  • G. Spaun
    • 3
  • F. Wrba
    • 4
  • E. Wenzl
    • 5
  • R. Schöfl
    • 6
  • F. Schreiber
    • 7
  • M. Häfner
    • 8
  • C. Madl
    • 9
  1. 1.Department of SurgeryMedical University of ViennaViennaAustria
  2. 2.Department of Internal Medicine IIBarmherzige BrüderEisenstadtAustria
  3. 3.Department of General and Visceral SurgeryKrankenhaus Barmherzige SchwesternLinzAustia
  4. 4.Clinical Institute for PathologyMedical University of ViennaViennaAustria
  5. 5.Department of SurgeryLandeskrankenhausFeldkirchAustria
  6. 6.Department of Internal Medicine IVElisabethinenLinzAustria
  7. 7.Department of Gastroenterology and HepatologyMedical University of GrazGrazAustria
  8. 8.Deparment of Internal MedicineSt. Elisabeth KrankenhausViennaAustria
  9. 9.Department of Gastroenterology, Hepatology, Endoscopy and OncologyRudolfstiftungViennaAustria

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