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Efficacy and Safety of Radiofrequency Ablation for Barrett's Esophagus with High Grade Dysplasia

the Washington University Experience

33

Oza, Aarti BA, MD*; Early, Dayna MD; Edmundowicz, Steven MD

American Journal of Gastroenterology: September 2008 - Volume 103 - Issue - p S14
Supplement Abstracts Submitted for the 73rd Annual Scientific Meeting of the American College of Gastroenterology: ESOPHAGUS
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Internal Medicine Division of Gastroenterology, Washington University, St. Louis, MO.

Purpose: The BARRX® system is an alternative to esophagectomy for patient with Barrett's esophagus (BE) and high grade dysplasia (HGD). It applies uniform, controlled radiofrequency ablation (RFA) at a consistent depth to remove the epithelial layer of cells of the esophageal wall allowing re-epithelialization by normal squamous mucosa. We report our single center experience using BARRX® RFA in BE patients with HGD.

Methods: We carried out a retrospective review of all BE patients (pts) with biopsy documented HGD treated with the BARRX® procedure at our institution from 2005 to 2008. The primary outcome was the histologic clearance of both intestinal metaplasia and dysplasia. Nodular BE was treated with EMR prior to RFA. All pts were treated with a combination of HALO 360® and HALO 90® ablation at 3 month intervals until all endoscopically visible BE was ablated. Pts were maintained on twice daily proton pump inhibitors. Follow up endoscopies were scheduled at 3 to 6 month intervals with jumbo forceps biopsies of the ablated mucosa, and any mucosa suspicious for persistent BE. All pathology was interpreted by Washington University pathologists. Pts enrolled in multicenter prospective treatment studies of HGD were excluded.

Results: Nineteen pts were identified that had initiated or completed BARRX® treatment. (77.2% male, mean age 72.3 years, all Caucasian). The mean length of BE was 6.32 cm. Five patients had short segment (<3 cm) BE (SSBE) and 14 had long segment BE (LSBE). One patient with LSBE is continuing active ablation. Eighteen patients completed RFA and were analyzed on an intention to treat basis. During therapy 2 patients (11%) progressed to adenocarcinoma (one patient developed invasive cancer), RFA was suspended, and both were not operative candidates. Sixteen patients have completed ablation therapy. In 12 patients (67%) after a median of 2.25 treatment sessions, there was complete histologic clearance of BE. In total, 83% of patients are free of dysplasia at follow-up. One pt relapsed with LGD 22 months after ablation. Complications occurred in 4 patients during treatment including chest pain (1), dysphagia (1), and strictures requiring a single balloon dilation (2).

Conclusion: BARRX® RFA treatment effectively eradicates dysplasia in 83% of patients with Barrett's esophagus and high grade dysplasia when analyzed on an intention to treat basis. Our results demonstrate adenocarcinoma can develop in patients with HGD undergoing ablative therapy. Long term follow up studies are needed to determine appropriate post RFA surveillance intervals, and the incidence of dysplasia recurrence.

© The American College of Gastroenterology 2008. All Rights Reserved.