Current Readings: Endoesophageal Management of Early Esophageal Cancer and Dysplastic Barrett Esophagus: A Review of Recent and Influential Studies

Abstract

DURABILITY OF RADIOFREQUENCY ABLATION IN BARRETT’S ESOPHAGUS WITH DYSPLASIA. Shaheen NJ, Bergein FO, Richard ES, et al. Gastroenterology 141(2):460-469, 2011. After multiple studies revealed that radiofrequency ablation (RFA) of Barrett esophagus (BE) with dysplasia was safe in selected cases, this randomized trial provided evidence that RFA is efficacious and durable in eradicating dysplastic BE. This trial is an extension of a previous study that documented excellent short-term results and sought to examine the long-term rates of pathologic eradication associated with RFA (compared with sham treatment) in patients with dysplastic BE. The extended follow-up is crucial to further validate that RFA can be used successfully to treat dysplastic BE without significant recurrences. In this randomized multisite trial, participants were recruited based on inclusion criteria that included age 18-80, endoscopically evident (nonnodular) BE, and length of BE o8 cm. Patients with esophageal cancer (EC) or poor life expectancy were excluded. Subjects were randomized to RFA or sham treatment at 2:1 ratio and received endoscopy with biopsy and treatment (or sham treatment) at 6 and 12 months (low-grade dysplasia arm), or 3, 6, 9, and 12 months (highgrade dysplasia [HGD] arm). After completion of the 12-month assessment, patients in the sham group were offered crossover to “open-label” RFA therapy. A total of 127 patients met the inclusion criteria and were randomized according to the study protocol (84 RFA, 43 sham). Of them, 117 (78 RFA, 39