Early experience with radiofrequency energy ablation therapy for Barrett’s esophagus with and without dysplasia (original) (raw)
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Endoscopic Ablation of Barrett’s Esophagus Using the Halo® System
Digestive Diseases, 2008
There is increasing interest in endoscopic treatment for Barrett's esophagus because it is the primary risk factor for adenocarcinoma of the esophagus, and the incidence is increasing. Of the various endoscopic treatments available, radiofrequency ablation is the one that has been studied the most. The principle of radiofrequency technology is to deliver a high power (approx. 300 W) over a short period of time (<300 ms) and to utilize energy density control. Recent studies suggest its utility for patients with low-grade dysplasia and high-grade dysplasia. In most instances, patients with intestinal metaplasia only with no dysplasia are followed with endoscopic surveillance rather than endoscopic treatment. Radiofrequency ablation treatment may be delivered by either a balloon device (HALO 360 ; HALO® system, BÂRRX, Sunnyvale, Calif., USA) or a paddle device attached to the tip of the endoscopy (HALO 90). After initial endoscopic treatment a repeat endoscopy is performed in 2-3 months to determine the completeness of the ablation. At the current time, even if there is no residual Barrett's seen at the follow-up examination, surveillance is still advised. This is because the device was first used in 2003 and long-term durability had not been established. It is hoped that when durability has been demonstrated for the removal of both metaplasia and dysplasia, long-term surveillance will not be needed.
Radiofrequency Ablation of Barrett's Esophagus: Short-Term Results
The Annals of Thoracic Surgery, 2009
Background. The presence of Barrett's esophagus (BE) increases the risk of esophageal cancer. Total regression of BE is uncommon with medication or laparoscopic fundoplication, and endoscopic techniques to obliterate BE have varied results. This study evaluated the early results of a balloon-based catheter radiofrequency ablation (RFA) system in patients with medically refractory reflux symptoms and biopsy-proven BE.
Radiofrequency Ablation of Barrett's Esophagus Containing High-Grade Dysplasia
Gastrointestinal Endoscopy, 2007
Background Barrett's esophagus (BE) is the morphological consequence of gastroesophageal reflux disease (GERD). Via low- and high-grade dysplasia, nondysplastic Barrett's esophagus (NDBE) may progress to cancer (0.1-0.6 % annual risk). We aim to summarize the impact of radiofrequency ablation (RFA) for the elimination of BE and cancer prevention.
Radiofrequency Ablation in Barrett's Esophagus with Dysplasia
New England Journal of Medicine, 2009
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. (ClinicalTrials.gov number, NCT00282672.)
Radiofrequency ablation of Barrett's esophagus using an overtube
Endoscopy, 2013
Background Barrett's esophagus (BE) is the morphological consequence of gastroesophageal reflux disease (GERD). Via low- and high-grade dysplasia, nondysplastic Barrett's esophagus (NDBE) may progress to cancer (0.1-0.6 % annual risk). We aim to summarize the impact of radiofrequency ablation (RFA) for the elimination of BE and cancer prevention.
Treatment of Barrett's Esophagus with radiofrequency ablation
Archives of Medical Science, 2023
Introduction: Barrett's esophagus (BE) represents the distal esophageal epithelium changes that carry a high risk of developing esophageal adenocarcinoma. One of the most challenging aspects of diagnosing BE by endoscopy is precisely discerning between normal epithelium and BE changes, which is essential for therapy success. The objectives of this study were to compare the success of radio-frequency ablation (RFA) therapy to conservative treatment with proton pump inhibitor (PPI) drugs between the clinical presentation and endoscopy findings of BE at 2, 6, 12, and 24 months after administered therapy. Material and methods: Seventy-five subjects were divided into two groups (RFA and PPI) based on the BE treatment regimen in this case-control study to compare the quality of treatments applied over a 24-month follow-up. Subjects who received RFA therapy were further divided into groups: those who received focal HALO 90 and those who received circumferential HALO 360, based primarily on EGDS findings or endoscopist experience. Results: The results show that using the RFA therapeutic modality in the treatment of BE is more effective (by 94.2% in the second month of follow-up, i.e., by 99% at the final visit after 24 months) than using PPI therapy alone. Re-RFA therapy was given to 15% of the subjects, mostly applied in the same therapeutic modality (HALO 90). Conclusions: Our findings show that RFA and re-RFA therapy have a high efficacy and safety profile, with no registered worsening of histology findings, the occurrence of esophageal adenocarcinoma, or adverse effects of the therapy.
Revista Colombiana De Gastroenterologia, 2014
Introduction: Barrett's esophagus (BE) is the result of chronic damage to the esophageal epithelium caused by the acid of gastrointestinal reflux diseases (GERD). It is defined as replacement of the by stratified squamous epithelium that normally lines the esophagus with metaplastic columnar epithelium. BE represents a risk factor for esophageal adenocarcinoma. The aim of radiofrequency ablation (RFA) is to destroy the metaplastic epithelium with the electric current of a radiofrequency to stimulate the reappearance of stratified squamous epithelium in the distal esophagus. Objective: The objective of this study was to evaluate the efficiency and safety of RFA which has recently been introduced in the city of Medellin, Colombia for management of BE with in situ dysplasia or carcinoma. Materials and Methods: Ten patients were treated with RFA. BE patients with in situ dysplasia or carcinoma and histological diagnoses were chosen for treatment. RFA procedures were done with BARRX equipment, the circular HALO360 system or the HALO90 system. Macroscopic and microscopic effects of RFA, patient tolerance to treatment and complications were evaluated. Results: A group of 10 patients received treatment with RFA. All ten finished treatment and follow-up. Seven patients had low-grade dysplasia, two had high-grade dysplasia, and one patient had in situ carcinoma. Two patients had undergone endoscopic resections of nodules and treatments of mucosa with bands prior to therapy with RFA. A total of 13 procedures were performed: 10 RFAs with the HALO360, 2 RFAs with the HALO90 and one argon plasma treatment for residual BE in one patient. Eradication of metaplastic and dysplastic esophageal epithelium was achieved in all patients and confirmed by endoscopic and histologic evaluation. No significant complications related to RFA were found, but in two patients esophageal stenoses were found. One required endoscopic dilatation three weeks after therapy. Conclusions: Based on these preliminary results we believe that this is a promising method that is welltolerated by patients and which has no major complications. Metaplastic and dysplastic epithelium of the distal esophagus were successfully eradicated in most patients.
Journal of Gastrointestinal Surgery, 2008
Background Radiofrequency ablation is safe and effective for complete eradication of nondysplastic Barrett esophagus (BE). The aim was to report the combined results of two published and two ongoing studies on radiofrequency ablation of BE with early neoplasia, as presented at SSAT presidential plenary session DDW 2008. Methods Enrolled patients had BE ≤12 cm with early neoplasia. Visible lesions were endoscopically resected. A balloonbased catheter was used for circumferential ablation and an endoscope-based catheter for focal ablation. Ablation was repeated every 2 months until the entire Barrett epithelium was endoscopically and histologically eradicated. Results Forty-four patients were included (35 men, median age 68 years, median BE 7 cm). Thirty-one patients first underwent endoscopic resection [early cancer (n=16), high-grade dysplasia (n=12), low-grade dysplasia (n=3)]. Worst histology remaining after resection was high-grade (n=32), low-grade (n=10), or no (n=2) dysplasia. After ablation, complete histological eradication of all dysplasia and intestinal metaplasia was achieved in 43 patients (98%). Complications following ablation were mucosal laceration at resection site (n=3) and transient dysphagia (n=4). After 21 months of follow-up (interquartile range 10-27), no dysplasia had recurred. Conclusions Radiofrequency ablation, with or without prior endoscopic resection for visible abnormalities, is effective and safe in eradicating BE and associated neoplasia.