BARRx for total Barrett’s eradication - the new super weapon?

Abstract

In this issue of Endoscopy, several pilot series appear to show the value of radiofrequency ablation (BARRx, HALO) in treating Barrett’s esophagus [1] [2] [3] [4], mostly with neoplastic changes, with the clear aim of total Barrett’s eradication. Initially, only circumferential ablation devices were used, later supplemented by a focal ablation device. Eradication rates of both Barrett’s esophagus and Barrett’s-associated neoplasia (if flat/invisible) are very high in the articles in this issue, with almost no complications. These reports follow an initial large series from the USA, which reported the treatment of nondysplastic Barrett’s esophagus, with a complete eradication rate of only 70 % initially [5]; later, with the help of focal ablation, a 98 % ablation rate of Barrett’s epithelium was reached [6]. Another large US registry series including only cases with high-grade dysplasia (HGIN) achieved a high eradication rate for HGIN (90 %), with only moderate results for eradicating all Barrett’s mucosa (54 %), but again only using the balloon device [7]. Other recent papers were either small or used BARRx only in special situations [8] [9].