Radiofrequency ablation highly effective in dysplastic Barrett’s esophagus

Radiofrequency ablation almost completely eradicated intestinal metaplasia and dysplasia, and reduced risk for disease progression in patients with Barrett’s esophagus.

Researchers randomly assigned 127 patients with dysplasia due to Barrett’s esophagus to radiofrequency ablation, a noninvasive technique that uses thermal energy to destroy cells (n=84), or a sham procedure (n=43).

Patients assigned to ablation were significantly more likely to have complete eradication of dysplasia than patients in the control group, according to the researchers. This was true for patients with high-grade dysplasia (81.0% vs. 19.0%; P<.001) and low-grade dysplasia (90.5% vs. 22.7%; P<.001).

Patients assigned to ablation were also more likely to have complete eradication of intestinal metaplasia than the control group (77.4% vs. 2.3%; P<.001) regardless of dysplasia level. Complete eradication of intestinal metaplasia with ablation was similar among patients with high-grade dysplasia and low-grade dysplasia (73.8% vs. 81.0%).

Progression of disease was more common in the control group than in the ablation group (16.3% vs. 3.6%; P=.03). In patients with high-grade dysplasia, more patients in the control group progressed to esophageal cancer than in the ablation group (19.0% vs. 2.4%; P=.04).

There were three serious adverse events in the ablation group and no adverse events in the control group, according to the researchers.

“The inclusion of a randomized sham-procedure group in the study design, the blinded evaluation of the primary endpoints, the low rate of loss to follow-up and the conservative intention-to-treat analysis make this a landmark study in the field,” Jacques Bergman, MD, PhD, from the department of gastroenterology and hepatology, Academic Medical Center, Amsterdam, wrote in an accompanying editorial.

Shaheen NJ. N Engl J Med. 2009;360:2277-2288.