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

Figures & data

Table 1 Competing methods for ablation of Barrett’s esophagus

Treatment	Mechanism of action	Eradication rate	Advantages	Disadvantages
Argon plasma coagulation (APC)	Ionized argon carrying high-frequency electrical current	80%–90%	Inexpensive Equipment widely available	Operator dependent Limited long-term outcome data Recurrence in some individuals
Photodynamic therapy (PDT)	Photosensitizing agent plus laser light activation via endoscope	50%–90%	Reproducible application technique	Expensive Equipment not widely available Photosensitivity limits applicability in many countries Recurrence in some individuals
Radiofrequency ablation therapy (RFA)	Bipolar electrical current	80%–90%	Simple reproducible application Equipment increasingly available	Expensive consumables Not suitable for nodular mucosa or difficult anatomy Recurrence in some individuals
Endoscopic mucosal resection (EMR)	Endoscopic removal of mucosa in piecemeal fashion	76%–l00%	Large tissue “biopsy” facilitates accurate histology Complete excision of shorter Barrett's esophagus segments feasible Can remove nodular lesions Can be used as an adjunct to other therapies	Excised mucosal pieces limited to 1.5–2 cm diameter. Piecemeal resection required for larger areas Complications in some individuals – bleeding, perforation, stricture
Endoscopic submucosal dissection (ESD)	Endoscopic removal of mucosa (single larger piece)	76%-l00%	Can remove nodular lesions More extensive “en bloc” resection of mucosa achievable	Long learning curve - technically challenging Higher stricture rate than following EMR Other complications - bleeding, perforation Procedures take a long time. Costly
Surgery	Esophagectomy	100%	Curative No further surveillance required after treatment	Perioperative morbidity, mortality Impact on quality of life

Table 2 Outcomes and complications following radiofrequency ablation

Outcomes
Eradication of intestinal metaplasia	54%-100%
Eradication of dysplastic lesions	83%–100%
Recurrence of Barrett’s esophagus	0%–32%
Progression of disease compared to controls	1.5% vs 26.5%^a 3.6% vs 16.3%^b
Complications
Chest pain	5%–28%
Mucosal lacerations	Relatively common
Stricture	0%–14%
Hemorrhage requiring intervention	Rare

Notes:

a Expert panel pathology review confirmed progression of LGD to HGD or adenocarcinoma;⁷³

b progression of disease determined when HGD progressed to cancer or LGD progressed to HGD or cancer.⁷⁹ These data are sourced from published randomized controlled trials.

Abbreviations: LGD, low-grade dysplasia; HGD, high-grade dysplasia.

Lyday WD, Corbett FS, Kuperman DA, et al. Radiofrequency ablation of Barrett’s esophagus: outcomes of 429 patients from a multicenter community practice registry. Endoscopy. 2010;42(4):272–278.

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Gupta M, Iyer PG, Lutzke L, et al. Recurrence of esophageal intestinal metaplasia after endoscopic mucosal resection and radiofrequency ablation of Barrett’s esophagus: results from a US Multicenter Consortium. Gastroenterology. 2013;145(1):79–86. e1.

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