Abstract
Background and study aims The standard radiofrequency ablation (RFA) protocol for Barrett’s esophagus (BE) encompasses an intermediary cleaning phase between two ablation sessions. A simplified protocol omitting the cleaning phase is less labor-intensive but equally effective in studies based on single ablation procedures. The aim of this study was to compare efficacy and safety of the standard and simplified RFA protocols for the whole treatment pathway for BE, including both circumferential and focal devices. Patients and methods We performed a retrospective analysis of prospectively collected data on patients receiving RFA between January 2007 and August 2017 at two institutions. Outcomes assessed were: 1) complete remission of dysplasia (CR-D) and intestinal metaplasia (CR-IM) at 18 months; and 2) rate of esophageal strictures. Results One hundred forty-five patients were included of whom 73 patients received the standard and 72 patients received the simplified protocol. CR-D was achieved in 94.5 % and 95.8 % of patients receiving the standard and simplified protocol, respectively ( P = 0.71). CR-IM was achieved in 84.9 % and 77.8 % of patients treated with the standard and simplified protocol, respectively ( P = 0.27). Strictures were significantly more common among patients who received the simplified protocol (12.5 %) compared to the standard protocol (1.4 %; P = 0.008). The median number of esophageal dilations was one. Conclusion The simplified RFA protocol is as effective as the standard protocol in eradicating BE but carries a higher risk of strictures. This needs to be taken into account, particularly in patients with higher pretreatment risk of strictures, such as those with esophageal narrowing from previous endoscopic mucosal resection (EMR).
Highlights
Barrett’s esophagus (BE) is a premalignant condition characterized by the replacement of the native esophageal squamous epithelium by columnar epithelial with intestinal metaplasia (IM) [1, 2]
Patients were eligible if they had flat BE with low-grade dysplasia (LGD) or high-grade dysplasia (HGD) and residual BE postendoscopic mucosal resection (EMR) for low-risk BE-related early cancer
Subsequent Radiofrequency ablation (RFA) studies on HGD and EAC, which assessed higher-energy dosimetry, showed that a (2 × 15 J/cm2-cleaning-2 × 15 J/cm2) resulted in better efficacy without compromising the complication rate [10]. This higher dosimetry was incorporated into European practices, the 2 x12 J/cm2-cleaning-2 × 12 J/cm2 was still favored in US-based studies for focal ablation [14]
Summary
Barrett’s esophagus (BE) is a premalignant condition characterized by the replacement of the native esophageal squamous epithelium by columnar epithelial with intestinal metaplasia (IM) [1, 2]. The most commonly applied protocol incorporates a cleaning phase, whereby debris from the ablated mucosa (one ablation at 12 J/cm for circumferential RFA or two ablations at 15 J/cm for focal RFA) is removed with cleaning devices, followed by a second round of ablation with an energy setting identical to the first [8 – 11]. This regimen is referred to as the “standard protocol.”.
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