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Endoscopic endoluminal radiofrequency ablation of Barrett’s esophagus: initial results and lessons learned

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Abstract

Background

Ablating Barrett’s epithelium may reduce the risk of developing esophageal adenocarcinoma. This study reports the experience of a single surgeon using an endoscopic endoluminal device that delivers radiofrequency energy (the BARRx device) to ablate Barrett’s esophagus.

Methods

All patients who underwent ablation of Barrett’s epithelium with the BARRx system were reviewed for length of Barrett’s metaplasia, presence of high-grade dysplasia, postprocedure complications, completeness of ablation at first follow-up endoscopy, need for additional ablation, completeness of ablation at second follow-up endoscopy, and concomitant performance of a Nissen fundoplication.

Results

Sixty-six patients underwent Barrett’s ablation. The median length of the Barrett’s esophagus was 3 (range, 1–14) cm. Twelve patients (18%) had high-grade dysplasia. There were no immediate procedure-related complications. Four strictures occurred: three in patients with ≥12-cm segments of Barrett’s and one in a 6-cm segment. Twenty-nine of 49 patients (59%) who had planned 3-month follow-up endoscopy had complete ablation. Five patients had planned two-stage ablation. Twenty patients with incomplete ablation had additional ablation. Twenty-seven patients had planned follow-up endoscopy at ≥1 year: 25 of 27 (93%) had biopsy-proven normal esophageal mucosa. The median length of Barrett’s esophagus in patients with initially incomplete ablation was 6 cm, compared with 2 cm in the initially complete ablation patients. Seven Nissen fundoplications were present at the time of ablation, whereas six were performed concomitantly with the ablation without increased difficulty.

Conclusions

Complete ablation of Barrett’s esophagus with radiofrequency endoluminal ablation is achievable in >90% of patients. Patients with longer segments are likely to require additional ablation. Patients with very long segments are at risk for stricture and should be approach cautiously. Performance of a fundoplication is not hindered by concomitant ablation.

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References

  1. Sharma P, McQuaid K, Dent J, Fennerty MB, Sampliner R, Spechlar S, Cameron A, Corely D, Falk G, Goldblum J, Hunter J, Jankowski J, Lundell L, Reid B, Shaheen NJ, Sonnenberg A, Wang K, Weinstein W (2004) AGA Chicago Workshop. A critical review of the diagnosis and management of Barrett’s esophagus: The AGA Chicago Workshop. Gastroenterology 127:310–330

    Article  PubMed  Google Scholar 

  2. Eckardt V, Kanzler G, Bernard G (2001) Life expectancy and cancer risk in patients with Barrett’s esophagus: a prospective controlled investigation. Am J Med 111:33–37

    Article  CAS  PubMed  Google Scholar 

  3. Fein M, Ireland AP, Ritter MP, Peters JH, Hagen JA, Bremner CG, DeMeester TR (1997) Duodenogastric reflux potentiates the injurious effects of gastroesophageal reflux. J Gastrointest Surg 1:27–33

    Article  CAS  PubMed  Google Scholar 

  4. Fein M, Maroske J, Fuchs K-H (2006) Importance of duodenogastric reflux in gastroesophageal reflux disease. Br J Surg 93:1475–1482

    Article  CAS  PubMed  Google Scholar 

  5. Bonino JA, Sharma P (2006) Barrett’s esophagus. Curr Opin Gastroenterol 22:406–411

    Article  PubMed  Google Scholar 

  6. Playford RJ (2006) New British Society of Gastroenterology (BSG) guidelines for the diagnosis and management of Barrett’s oesophagus. Gut 55:442–443

    Article  CAS  PubMed  Google Scholar 

  7. Sampliner RE (2002) Updated guidelines for the diagnosis, surveillance, and therapy of Barrett’s esophagus. Am J Gastroenterol 97:1888–1895

    Article  PubMed  Google Scholar 

  8. Sampliner R (2004) Endoscopic ablative therapy for Barrett’s esophagus: current status. Gastrointest Endosc 59:66–69

    Article  PubMed  Google Scholar 

  9. Bergman JJGHM, Fockens P (2006) Ablating Barrett’s metaplastic epithelium: are the techniques ready for clinical use? Gut 55:1222–1223

    Article  CAS  PubMed  Google Scholar 

  10. Spechlar SJ (2006) Thermal ablation of Barrett’s esophagus: a heated debate. Am J Gastroenterol 101:1770–1772

    Article  Google Scholar 

  11. Ganz RA, Utley DS, Stern RA, Jackson J, Batts KP, Temin P (2004) Complete ablation of esophageal epithelium with a balloon-based bipolar electrode: a phased evaluation in the porcine and in the human esophagus. Gastrointest Endosc 60:1002–1010

    Article  PubMed  Google Scholar 

  12. Dunkin BJ, Martinez J, Bejarano PA, Smith CD, Chang K, Livingstone AS, Melvin WS (2006) Thin-layer ablation of human esophageal epithelium using a bipolar radiofrequency balloon device (BARRX). Surg Endosc 20:125–130

    Article  CAS  PubMed  Google Scholar 

  13. Smith CD, Bejarano PA, Melvin WS, Patti MG, Muthusamy R, Dunkin BJ (2007) Endoscopic ablation of intestinal metaplasia containing high-grade dysplasia in esophagectomy patients using a balloon-based ablation system. Surg Endosc 21:560–569

    Article  CAS  PubMed  Google Scholar 

  14. 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. Gastrointest Endosc 65:185–195

    Article  PubMed  Google Scholar 

  15. Hubbard N, Velanovich V (2007) Endoscopic endoluminal radiofrequency ablation of Barrett’s esophagus in patients with fundoplications. Surg Endosc 21:625–628

    Article  CAS  PubMed  Google Scholar 

  16. Rice TW, Sontag SJ, Lightdale CJ (2006) Esophagectomy is the treatment of choice for high-grade dysplasia in Barrett’s esophagus. Am J Gastroenterol 101:2177–2184

    Article  PubMed  Google Scholar 

  17. Horwhat JD, Baroni D, Maydonovitch C, Osgard E, Ormseth E, Rudeo-Padarza E, Lee HJ, Hirota WK, Wong RK (2006) Normalization of intestinal metaplasia in the esophagus and esophagogastric junction: incidence and clinical data. Am J Gastroenterol 101:1–10

    Article  Google Scholar 

  18. Garside R, Pitt M, Somerville M, Stein K, Price A, Gilbert N (2006) Surveillance of Barrett’s oesophagus: exploring the uncertainty through systematic review, expert workshop and economic modeling. Health Technol Assess 10(8):1–142

    Google Scholar 

  19. Bampton PA, Schloithe A, Bull J, Fraser RJ, Padbury RT, Watson DI (2006) Improving surveillance for Barrett’s oesophagus. BMJ 332:1320–1323

    Article  PubMed  Google Scholar 

  20. Ragunath K, Krasner N, Raman VS, Haqqani MT, Philips CJ, Cheung I (2005) Endoscopic ablation of dysplastic Barrett’s oesophagus comparing argon plasma coagulation and photodynamic therapy: a randomized trial assessing efficacy and cost-effectiveness. Scand J Gastroenterol 7:750–758

    Article  Google Scholar 

  21. Ferraris R, Fracchia M, Foti M, Sidoli L, Taraglio S, Vigano L, Ciaccone C, Rebecchi F, Meineri G, Senore C, Pera A (2007) Gruppo Operativo Studio Precancerosi Esofagee. Barrett’s oesophagus: long-term follow-up after complete ablation with argon plasma coagulation and the factors that determine recurrence. Aliment Pharmacol Ther 25:835–840

    Article  CAS  PubMed  Google Scholar 

  22. Overholt BF, Lightdale CJ, Wang KK, Canto MI, Burdick S, Haggitt RC, Bronner MP, Taylor SL, Grace MG, Depot M (2005) International Photodynamic Group for High Grade Dysplasia in Barrett’s Esophagus. Photodynamic therapy with porfimer sodium for ablation of high-grade dysplasia in Barrett’s esophagus: international partially blinded, randomized phase III trial. Gastrointest Endosc 62:488–498

    Article  PubMed  Google Scholar 

  23. Prasad GA, Wang KW, Buttnar NS, Wongkeesong LM, Lutzke LS, Borkenhagen LS (2007) Predictors of stricture formation after photodynamic therapy for high-grade dysplasia in Barrett’s esophagus. Gastrointest Endosc 65:60–66

    Article  PubMed  Google Scholar 

  24. Johnston MH, Eastone JA, Horwhat JD, Cartledge J, Mathews JS, Foggy JR (2005) Cryoablation of Barrett’s esophagus: a pilot study. Gastrointest Endosc 62:842–848

    Article  PubMed  Google Scholar 

  25. Weston AP (2005) Can deep freezing join the endoscopic Barrett’s mucosal ablation party? Cautious optimism is warranted. Gastrointest Endosc 62:849–852

    Article  PubMed  Google Scholar 

  26. Roorda AK, Marcus SN, Triadafilopoulous G (2007) Early experience with radiofrequency energy ablation therapy for Barrett’s esophagus with and without dysplasia. Dis Esophagus 20:516–522

    Article  CAS  PubMed  Google Scholar 

  27. Dellon ES, Shaheen NJ (2007) Barrett’s esophagus and the costs of “doing something”. Gastrointest Endosc 65:31–35

    Article  PubMed  Google Scholar 

  28. Sharma P, Falk GW, Weston AP, Reker D, Johnston M, Sampliner RE (2006) Dysplasia and cancer in a large multicenter cohort of patients with Barrett’s esophagus. Clin Gastroenterol Hepatol 4:566–572

    Article  PubMed  Google Scholar 

  29. Rastogi A, Puli S, El-Serag HB, Bansal A, Wani S, Sharma P (2008) Incidence of esophageal adenocarcinoma in patients with Barrett’s esophagus and high-grade dysplasia: a meta-analysis. Gastrointest Endosc 67:394–398

    Article  PubMed  Google Scholar 

  30. Winawer SJ, Zauber AG, Ho MN, O’Brien MJ, Gottlieb LS, Stemberg SS, Waye JD, Schapiro M, Bond JH, Parrish J (1993) Prevention of colorectal cancer by polypectomy: The National Polyp Study Workgroup. N Engl J Med 329:1977–1981

    Article  CAS  PubMed  Google Scholar 

  31. Velanovich V (2007) How many cancers need to be prevented to make ablation of Barrett’s esophagus cost-effective? Presented at the 2007 annual scientific sessions of the Society of American Gastrointestinal and Endoscopic Surgeons, Las Vegas, NV, April (abstract published in Surg Endosc)

  32. 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, Eysselien VE, Panjehpour M, Triafilopoulos G (2008) U.S. Multicenter Registry. Circumferential ablation of Barrett’s esophagus that contains high-grade dysplasia: a U.S. multicenter registry. Gastrointest Endosc 68:35–40

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Division of General Surgery, K-8, Henry Ford Hospital, 2799 West Grand Blvd., Detroit, MI, 48202-2689, USA

    Vic Velanovich

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  1. Vic Velanovich
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Correspondence to Vic Velanovich.

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Velanovich, V. Endoscopic endoluminal radiofrequency ablation of Barrett’s esophagus: initial results and lessons learned. Surg Endosc 23, 2175–2180 (2009). https://doi.org/10.1007/s00464-009-0364-z

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  • DOI: https://doi.org/10.1007/s00464-009-0364-z

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