Clinical Outcomes of Patients with Barrettʼs Esophagus Treated with Radiofrequency Ablation Using Only the Focal Device

Abstract

Purpose: Endoscopic eradication therapy with radiofrequency ablation (RFA) is an effective method to achieve reversion of metaplastic epithelium to normal-appearing squamous epithelium in patients with Barrett's esophagus (BE). The HALO 90 focal ablation device is attached to the distal end of an endoscope, and is generally used in follow-up treatments for focal residual Barrett's after prior treatment with the circumferential ablation balloon device (HALO 360). However, outcomes of patients with BE who were treated solely with the focal ablation device have rarely been reported. Methods: We analyzed the data from a cohort of patients with BE who were treated with RFA from June, 2004 to April, 2011 at a single referral center. Fifty-eight patients (46 men, 12 women: mean age 64.6±9.9 years) who had their RFA treatments using only HALO 90 were enrolled in the study. Complete response (CR) was defined as complete eradiation of all dysplasia and intestinal metaplasia. Recurrence was defined as any biopsy from the esophagus showing intestinal metaplasia. Results: Baseline histology prior to RFA: non-dysplastic BE, n=24 (41.4%), low grade dysplasia, n=14 (24.1%), high grade dysplasia and intramucosal carcinoma, n=20 (34.5%). Mean length of Barrett's mucosa was 2.5±2.0 cm. Mean size of hiatal hernia was 1.9±1.3 cm. Endoscopic mucosal resection (EMR) was performed in 11 cases (19.0%) prior to RFA. Fundoplication was performed in three cases (5.2%) prior to RFA. Mean ablations per session was 48.7±18.2. CR was achieved in 56 cases (96.6%). Median number of RFA sessions to CR was two (range 1-5). CR within three RFA sessions (CR3) was achieved in 53 cases (91.4%): CR3 was 97.2% in BE ≤ 2 cm, 89.5% in BE > 2 cm and ≤ 4 cm, and 33.3% in BE > 4 cm. Patients were followed up for mean 25±15 months. One case (1.7%) recurred as low grade dysplasia and was successfully treated with EMR. Symptomatic stricture requiring dilation occurred in two cases (3.4%). There were no buried glands detected. Conclusion: RFA therapy in patients with BE using only the HALO 90 focal device is effective and safe, even in longer segments. CR within three RFA sessions was achieved in 94.5% (52/55) of patient with BE ≤ 4 cm. Disclosure - Dr. Chang: Barrx Covidien - Consultant, Olympus Japan - Consultant, Cook Medical - Consultant Dr. Lee: Cook Medical - speaker's bureau - honorarium Dr. Samarasena: Barrx Covidien - honorarium.