Circumferential Balloon-Based Radiofrequency Ablation of Barrett's Esophagus Using the HALO 360 Ablation System Preserves the Inner Diameter of the Esophagus and Prevents Subsequent Narrowing and Compliance Reduction

Abstract

Circumferential Balloon-Based Radiofrequency Ablation of Barrett’s Esophagus Using the HALO 360 Ablation System Preserves the Inner Diameter of the Esophagus and Prevents Subsequent Narrowing and Compliance Reduction Jacques J. Bergman, Carine Sondermeijer, Femke P. Peters, Fiebo J. Ten Kate, Paul Fockens Background: Circumferential balloon-based radiofrequency (RF) energy ablation is a promising endoscopic technique for treatment of dysplasia in Barrett’s esophagus (BE). Previous studies suggest that RF ablation, contrary to other ablative and resective techniques, does not result in significant scarring or stricturing. Patients and Methods: Patients with BE and high-grade dysplasia (HGD) or low-grade dysplasia (LGD) were included. Visible abnormalities were removed by endoscopic resection (ER) at least 6 weeks prior to ablation. Patients used esomeprazole 40 mg BID during the study. Prior to ablation, the inner diameter (ID) of the esophagus was measured with a non-compliant balloon (HALO-360 System, BÂRRX Medical, Sunnyvale, CA), introduced over a guidewire and positioned 3 cm above the proximal margin of BE. The balloon was inflated to 4 psi (0.28 atm) for 6 secs. The ID was calculated based on baseline balloon volume/geometry, and the inflated pressure/volume. Sizing was repeated for every 1 cm of BE until the transition to cardia was detected by a rapid increase in ID. An ablation catheter was selected according to esophageal ID. Circumferential RF ablation was performed from the proximal margin of BE to the top of the gastric folds using 12 J/cm delivered twice. Results: 11 patients (8 male) with a median age of 60 yrs (IQR 55-67) and a median BE length of 5 cm (IQR 3-7) were included. At baseline, 10 patients had HGD and one patient had LGD. There were no serious adverse events associated with sizing or ablation. At 10 weeks, there were no strictures or narrowing and the median reduction in BE surface area was 90% (range 60-99%), with only small foci or tongues remaining. The median esophageal ID was 28.6 mm (IQR 25.6-32.8 mm) at baseline and 28.6 mm (IQR 25.8 31.1 mm) at 10 weeks (p Z 0.48, paired Student t-test). Conclusion: This is the first report of the effects of circumferential RF ablation of BE on the ID of the treated esophagus. As measured with this pressure/volume system, ID is related to compliance. There was no difference between baseline and 10 weeks post-ablation ID/compliance of the treated esophagus, suggesting that a functional esophagus is preserved after this treatment. Other potential applications of this sizing device may be the characterization of esophageal motility complaints and assessment of stricture dilation results.