Combined Radiofrequency and Cryoablation in Barrettʼs Esophagus Eradication

Abstract

Purpose: Radiofrequency ablation (RFA) is increasingly used for eradication of Barrett's esophagus (BE). Our experience indicates, however, that RFA is less effective near the gastro-esophageal junction where contact with RFA devices could be hampered by the funneled shape esophagus, especially in the presence of hiatal hernia. Cryoablation has recently emerged as a promising alternative technique and does not require close contact between the device and mucosa. The aim of our study was to evaluate the efficacy of RFA followed by cryoablation as an adjuvant therapy for BE. Methods: This is an ongoing study; all patients were treated from 2005 onwards. Data were collected with regard to: BE length, grade of dysplasia, and treatment provided. Most patients initially had circumferential RFA with balloon-based HALO360, followed by plate-based RFA with HALO90 for small residual BE (both devices Covidien, MA). If after 2-3 RFA sessions small residual BE was still present, cryoablation was performed. Any mucosal irregularities or nodules were removed by EMR prior to ablative therapy. Complete BE eradication was confirmed by all-negative four quadrant biopsies taken every 1 cm. Results: Study involved 53 patients (Table). Mean follow up was 12 months (range, 1-54 months). Average BE length was 3.94 cm (1-20 cm). 8 patients had dysplasia (4 high grade, 4 low grade). To date, 22/53 (42%) patients cleared BE. 16/53 (30%) patients are receiving ongoing therapy. All dysplasia has been successfully treated to at least non-dysplastic except for one patient who was lost to follow up. Dual therapy was required to completely eradicate BE in 4 patients with previous dysplasia; 2 patients had cleared dysplasia (one with RFA alone, the other with dual therapy) but have residual sub-centimeter islands of BE and are undergoing repeat ablations; in 1 patient nodular high-grade dysplasia was removed by EMR. 15 patients were lost to follow-up. Comparing RFA plus cryoablation to RFA alone: long-segment BE was eradicated in 7/12 (58%) of cases vs. 3/9 (33%); short-segment BE, in 4/5 (80%) of cases vs. 4/10 (40%).Table: No Caption available.Conclusion: In our experience, cryotherapy in combination with RFA increases the likelihood of complete BE eradication and should be considered when several attempts at RFA have failed.