Radiofrequency ablation (RFA) leads to remission for 91 percent of patients with dysplastic Barrett's esophagus, according to new figures published in Clinical Gastroenterology and Hepatology, the official clinical practice journal of the American Gastroenterological Association. Dysplastic Barrett's esophagus is the most serious grade of the condition in which precancerous cells are detected in the esophagus.
"In order to make appropriate informed decisions about the use of radiofrequency ablation, patients and providers need to be well versed in the risks and benefits of the procedure," said Nicholas J. Shaheen, MD, MPH, AGAF, study author from the Center for Esophageal Diseases and Swallowing at the University of North Carolina School of Medicine. "This study fills an important gap in research by combining the results of several smaller studies. We now have dependable figures showing that radiofrequency ablation is a safe and effective treatment for most patients with dysplastic Barrett's esophagus."
Investigators conducted a systematic review and meta-analysis of studies published in PubMed and EMBASE to determine trends among Barrett's esophagus patients with intestinal metaplasia (the first phase of the condition in which intestine-like cells develop in the esophagus) and dysplastic Barrett's esophagus. In addition to the high percentage of patients who achieved complete eradication of dysplasia, the investigators reported that complete eradication of intestinal metaplasia was achieved in 78 percent of patients.
The study also found that 13 percent of patients had recurrent intestinal metaplasia after successful eradication. While not substantial, this data should serve as a warning that physicians must keep patients in a surveillance program after completion of therapy. Adverse events (most commonly narrowing of the esophagus, pain and bleeding) were reported in less than 5 percent of patients.
Further analysis and follow up of the U.S. RFA Registry, a nationwide registry of patients treated with radiofrequency ablation for Barrett's esophagus, will be helpful in enhancing generalizability and defining radiofrequency ablation effectiveness in the broader population of patients with Barrett's esophagus.
Radiofrequency ablation is a minimally invasive treatment for Barrett's esophagus in which the inner lining of the esophagus is destroyed by applying high radiofrequency waves to it, causing a thermal injury or "burn." When these abnormal or precancerous cells are destroyed, normal tissue usually regenerates in its place.
- Eric S. Orman, Nan Li, Nicholas J. Shaheen. Efficacy and Durability of Radiofrequency Ablation for Barrett's Esophagus: Systematic Review and Meta-analysis. Clinical Gastroenterology and Hepatology, 2013; 11 (10): 1245 DOI: 10.1016/j.cgh.2013.03.039
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