Radiofrequency ablation for Barrett's esophagus and low-grade dysplasia in combination with an antireflux procedure: A new paradigm

dos Santos, Ricardo S.; Bizekis, Costas; Ebright, Michael; DeSimone, Michael; Daly, Benedict D.; Fernando, Hiran C.

doi:10.1016/j.jtcvs.2009.10.032

« Previous Next »The Journal of Thoracic and Cardiovascular Surgery
Volume 139, Issue 3 , Pages 713-716, March 2010

Radiofrequency ablation for Barrett's esophagus and low-grade dysplasia in combination with an antireflux procedure: A new paradigm

Read at the Thirty-fifth Annual Meeting of The Western Thoracic Surgical Association, Banff, Alberta, Canada, June 24–27, 2009.

Ricardo S. dos Santos, MD
- Department of Cardiothoracic Surgery, Boston University School of Medicine, Boston, Mass
- Instituto Israelita de Ensino e Pesquisa Albert Einstein, São Paulo, Brazil
Costas Bizekis, MD
- Department of Cardiothoracic Surgery, New York University School of Medicine, New York, NY
Michael Ebright, MD
- Department of Cardiothoracic Surgery, Boston University School of Medicine, Boston, Mass
Michael DeSimone
- Department of Cardiothoracic Surgery, Boston University School of Medicine, Boston, Mass
Benedict D. Daly, MD
- Department of Cardiothoracic Surgery, Boston University School of Medicine, Boston, Mass
Hiran C. Fernando, MD
- Department of Cardiothoracic Surgery, Boston University School of Medicine, Boston, Mass
- Address for reprints: Hiran C. Fernando, MD, Boston Medical Center, 88 East Newton St, Robinson B402, Boston, MA 02118.

Received 26 June 2009; received in revised form 13 September 2009; accepted 16 October 2009. published online 14 January 2010.

Objective

Radiofrequency ablation for Barrett's esophagus in combination with an antireflux procedure has not been widely documented. We report our initial experience with radiofrequency ablation in association with antireflux procedure for Barrett's metaplasia and low-grade dysplasia.

Methods

A total of 14 patients (10 male and 4 female patients) presented with Barrett's metaplasia (n=11) or low-grade dysplasia (n=3). Median age was 60 years (38–80 years). The severity of Barrett's esophagus was classified by length (in centimeters), appearance (circumferential/noncircumferential), and histology (1, normal; 2, Barrett's metaplasia; and 3, low-grade dysplasia). Radiofrequency ablation was performed with the HALO 360° or 90° systems (BARRX Medical, Sunnyvale, Calif).

Results

Median follow-up was 17 months. The mean number of ablative procedures undertaken was 2.6 (range, 1–6). There was no mortality, but there were 2 perioperative complications after the antireflux procedure (pneumonia, 1; atrial fibrillation, 1). One patient had mild dysphagia requiring a single dilation 2 months after ablation. The mean length of Barrett's esophagus decreased from 6.2 to 1.2cm after treatment (P=.001). Barrett's grade decreased significantly (P=.003). Before therapy, circumferential Barrett's esophagus was present in 13 patients. At last endoscopy, only 1 patient had circumferential Barrett's esophagus present. The number of radiofrequency ablation treatments was significantly (P < .05) associated with success. All patients receiving 3 or more treatments had complete resolution of Barrett's metaplasia.

Conclusions

Radiofrequency ablation performed either before or after an antireflux procedure is safe. This approach is effective for reducing or eliminating metaplasia and dysplasia. Long-term studies will be necessary to determine whether this approach can provide durable control of both reflux and Barrett's esophagus.

CTSNet classification: 7, 8.1

Abbreviations and Acronyms: GERD, gastroesophageal reflux disease, RFA, radiofrequency ablation