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Endoscopic radiofrequency ablation therapy for the prevention of esophageal cancer in Barrett’s esophagus

Authors Ha NH, Hummel R, Watson D

Received 13 April 2015

Accepted for publication 29 May 2015

Published 29 July 2015 Volume 2015:5 Pages 111—121


Checked for plagiarism Yes

Review by Single anonymous peer review

Peer reviewer comments 2

Editor who approved publication: Dr Eileen O'Reilly

Ngoc Hoang Ha, Richard Hummel, David I Watson

Department of Surgery, Flinders University, Flinders Medical Centre, Bedford Park, Adelaide, South Australia, Australia

Abstract: Barrett’s esophagus is the only known precursor lesion for esophageal adenocarcinoma. Previous studies have shown that a variety of methods can be applied to destroy Barrett’s esophagus epithelium, and healing with a new esophageal squamous epithelium usually occurs following ablation. Radiofrequency ablation (RFA) is a relatively new endoscopic technique. It has been claimed that ablation using RFA reduces the risk of cancer progression. RFA is usually easy to apply and is associated with a low risk of morbidity. It achieves complete eradication of (non) dysplastic Barrett’s esophagus in most individuals, and the risk of progression to higher grades of dysplasia or cancer is reduced after RFA, although not completely eliminated. Limitations include recurrence of Barrett’s esophagus in up to one-third of individuals, a risk of “buried islands” of Barrett’s esophagus remaining below the regenerated mucosa, and uncertainty about the biological behavior of the new squamous epithelium after RFA. Current evidence supports the use of RFA in individuals with high-grade dysplasia in Barrett’s esophagus, and early stage (T1a) intramucosal cancer, and select individuals with low-grade dysplasia. As accurate diagnosis of low-grade dysplasia remains difficult outside expert centers, it is probably premature to recommend routine RFA for all patients diagnosed with low-grade dysplasia in the community, despite the favorable outcomes from one randomized trial. Furthermore, long-term outcomes following ablation remain uncertain, and ongoing endoscopy surveillance is still required after RFA as progression to cancer remains a possibility. Outcomes from large studies with long-term follow-up are needed to definitively confirm that RFA ablation can reliably prevent cancer progression in Barrett’s esophagus.

Keywords: Barrett’s esophagus, esophageal adenocarcinoma, radiofrequency ablation, dysplasia

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