Barrett's esophagus, a condition of intestinal metaplasia of the esophagus, is associated with an increased risk of esophageal adenocarcinoma.
Dr Nicholas Shaheen and colleagues assessed whether endoscopic radiofrequency ablation could eradicate dysplastic Barrett's esophagus, and decrease the rate of neoplastic progression.
The team designed a multicenter, sham-controlled trial, of 127 patients with dysplastic Barrett's esophagus in a 2:1 ratio to receive either radiofrequency ablation or a sham procedure.
Randomization was stratified according to the grade of dysplasia and the length of Barrett's esophagus.
Primary outcomes at 12 months included the complete eradication of dysplasia and intestinal metaplasia.
|Complete eradication of dysplasia occurred in 91% after ablation|
| New England Journal of Medicine|
The researchers applied intention-to-treat analyses.
Among patients with low-grade dysplasia, complete eradication of dysplasia occurred in 91% of those in the ablation group, as compared with 23% of those in the control group.
The team noted that among patients with high-grade dysplasia, complete eradication occurred in 81% of those in the ablation group, as compared with 19% of those in the control group.
Overall, 77% of patients in the ablation group had complete eradication of intestinal metaplasia, as compared with 2% of those in the control group.
The research team found that patients in the ablation group had less disease progression and fewer cancers.
Patients reported having more chest pain after the ablation procedure than after the sham procedure.
In the ablation group, the researchers observed that 1 patient had upper gastrointestinal hemorrhage, and 5 patients had esophageal stricture.
Dr Shaheen's team concluded, “In patients with dysplastic Barrett's esophagus, radiofrequency ablation was associated with a high rate of complete eradication of both dysplasia and intestinal metaplasia and a reduced risk of disease progression.”