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RF ablation safe, durable for intramucosal carcinomas in Barrett’s esophagus
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LAS VEGAS — Intramucosal carcinomas in patients with dysplastic Barrett’s esophagus were safely and effectively eradicated via radiofrequency ablation in a study presented at the 2012 American College of Gastroenterology Annual Scientific Meeting.
Researchers performed a retrospective review of data from 20 patients with intramucosal carcinoma (IMC) and Barrett’s esophagus collected from a single tertiary care facility over 5 years. The median length of Barrett’s esophagus was 4.5 cm (range 1-14 cm), with five cases having lasted for longer than 10 years. Six patients had esophagitis and five had strictures at baseline, and three had a family history of esophageal adenocarcinoma.
All patients underwent radiofrequency ablation (RFA), with endoscopic mucosal resection (EMR) occurring in 14 cases with nodular lesions. Upon achieving complete response — eradication of all intestinal metaplasia and/or dysplasia — patients were monitored every 3 months for 1 year, then annually.
“RFA, with or without EMR, has been validated as a safe, effective and durable treatment option for dysplastic Barrett’s esophagus eradication,” the researchers wrote. “Its use in IMC, however, is unclear. We aimed to assess the long-term safety and efficacy of RFA, with or without EMR, for IMC eradication.”
Complete eradication of dysplasia occurred in 18 cases, with high-grade dysplasia remaining in one patient and another choosing to undergo esophagectomy before a second ablation, with no malignancy or dysplasia observed. Coexisting high-grade dysplasia had been present in 17 cases at initial biopsy. Complete intestinal metaplasia eradication occurred in 16 cases. No recurrence of either dysplasia or metaplasia was observed for a mean of 32 ± 14 months after RFA.
One patient experienced a self-limited bleeding episode during treatment, and strictures occurred in five patients, all of which resolved after one to three dilations per stricture. Investigators also noted that four patients who experienced strictures received EMR prior to ablation.
“Radiofrequency ablation can be used to treat intramucosal carcinoma in Barrett’s esophagus,” researcher Parambir S. Dulai, MD, medical resident at in , told Healio.com. “There is 3-year treatment durability … but we do need to follow these patients very closely, because it can recur within the first 2 years. [However,] most patients, regardless of how long their Barrett’s esophagus is or what their baseline diseases are, can be treated with EMR and RFA.”
Disclosure: Richard I. Rothstein and Stuart R. Gordon have received research support from BARRX Medical Inc., which developed the devices used to perform RFA.
For more information:
Dulai PS. P562: Long-term Results After Radiofrequency Ablation for Intramucosal Carcinoma in Barrett’s Esophagus. Presented at: the 2012 American College of Gastroenterology Annual Scientific Meeting; Oct. 19-24, Las Vegas.