Radiofrequency Ablation in Barrett’s Esophagus May Prevent Esophageal Cancer
Treatment of Barrett’s esophagus with radiofrequency ablation appears to keep the condition from progressing to esophageal cancer. These findings were published in the Journal of the American Medical Association.
Barrett’s esophagus is a pre-cancerous condition of the esophagus. It means that there is a type of cell called columnar epithelial cells present in the surface lining of the lower esophagus. Typically, the surface lining of the lower esophagus should only contain squamous cells; however reflux of stomach contents, especially acid, into the esophagus causes these squamous cells to be replaced by columnar epithelial cells more similar to those found in the stomach and intestines.
Barrett’s esophagus can have different levels of what’s known as dysplasia, or number of abnormal cells. In low-grade dysplasia, some of the cells look somewhat abnormal under the microscope; this is a very early form of pre-cancer of the esophagus. In high-grade dysplasia, some of the cells look very abnormal under the microscope; this is a more advanced pre-cancer of the esophagus than low-grade dysplasia.
Effective treatment of Barrett’s esophagus can keep the condition from progressing to esophageal cancer. But because relatively few cases of Barrett’s esophagus progress to cancer, many patients are not actively treated and instead undergo surveillance (or “watch and wait”) until signs of progression.
A procedure called radiofrequency ablation can be used to treat Barrett’s esophagus. During radiofrequency ablation, a doctor places an endoscope (a thin, lighted tube) down your esophagus. The tube has a small balloon at the end, which has electrodes on its outer surface. When the balloon is inflated inside the esophagus, the electrodes deliver heat and energy to destroy the abnormal tissue of Barrett’s esophagus. The electrodes target the diseased tissue so that there is minimal damage to healthy tissue.
Researchers from several institutions in Europe created a clinical trial to study how effectively radiofrequency ablation could prevent Barrett’s esophagus from progressing to esophageal cancer. They enrolled 136 patients who had been diagnosed with Barrett’s esophagus with low-grade dysplasia. Patients were divided into two groups:
- One group received radiofrequency ablation for a maximum of five treatments (68 patients).
- One group received only surveillance with an endoscope (68 patients).
At a follow-up of three years, patients who received radiofrequency ablation had a lower rate of progression from low-grade to high-grade dysplasia or esophageal cancer. The radiofrequency ablation group had a reduced risk of developing high-grade dysplasia of 25% and a reduced risk of developing esophageal cancer of 7.4%, compared with those who received surveillance only. Ablation appeared to eradicate dysplasia in 93% of patients who underwent the procedure, compared with 28% of those who didn’t undergo ablation. As well, ablation also got rid of what’s known as intestinal metaplasia (when cells normally found in the intestines develop in the esophagus) in 88% of patients, compared with 0% of patients who didn’t receive ablation.
Side effects with ablation were not significant and were effectively treated. Eight patients who received ablation experienced a narrowing or tightening of the esophagus (stricture). Each of these cases was successfully treated with a procedure called endoscopic dilation (stretching of esophagus using endoscope).
Based on the significantly improved outcomes with radiofrequency ablation, the trial was stopped early. These findings suggest that radiofrequency ablation appears to effectively keep Barrett’s esophagus with low-grade dysplasia from progressing to high-grade dysplasia or esophageal cancer.
Reference: Phoa KN, van Vilsteren FG, Weusten BL, et al. Radiofrequency Ablation vs Endoscopic Surveillance for Patients with Barrett Esophagus and Low-Grade Dysplasia: a Randomized Clinical Trial. Journal of the American Medical Association. 2014 Mar 26;311(12):1209-17. doi: 10.1001/jama.2014.2511.