For patients with Barrett's esophagus, life-long surveillance endoscopy is recommended because of an elevated risk for developing dysplasia and esophageal adenocarcinoma.
Various endoscopic therapies have been used to eradicate Barrett's esophagus.
Recently circumferential radiofrequency ablation has been used with encouraging short-term results.
Dr David Fleischer and colleagues from Arizona, USA assessed the long-term safety and efficacy of step-wise circumferential ablation with the addition of focal ablation for Barrett's esophagus.
The research team evaluated 70 subjects with 2 to 6 cm of Barrett's esophagus and histologic evidence of intestinal metaplasia.
|Complete remission was achieved in 70%|
|Gasrointestinal Endoscopy |
The team performed circumferential ablation at baseline, repeated at 4 months if there was residual intestinal metaplasia.
Follow-up biopsy specimens were obtained at 1, 3, 6, 12, and 30 months.
Specimens were reviewed by a central pathology board.
Focal ablation was performed after the 12-month follow-up for histological evidence of intestinal metaplasia at the 12-month biopsy or endoscopic appearance suggestive of columnar-lined esophagus.
Subjects received esomeprazole for control of esophageal reflux.
The team found complete absence of intestinal metaplasia per patient from biopsy specimens obtained at 12 and 30 months, defined as complete remission–intestinal metaplasia.
The researchers found at 12 months, that complete remission was achieved in 70% per protocol analysis.
At 30 months after additional focal ablative therapy, complete remission was achieved in 98%.
There were no strictures or buried glandular mucosa detected by the standardized biopsy protocol at 12 or 30 months, and there were no serious adverse events.
This was an uncontrolled clinical trial with 2.5-year follow-up.
Dr Fleischer’s team concluded, “Stepwise circumferential and focal ablation resulted in complete eradication of intestinal metaplasia in 98% of patients at 2.5-year follow-up.”