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Radiofrequency Ablation (RFA) for Barrett’s and Low Grade Dysplasia in Combination with an Antireflux Surgery; a New Paradigm
Ricardo Santos1, Costas Bizikis2, Michael Ebright1, Michael DeSimone1, Benedict Daly1, Hiran C. Fernando1
1Boston Medical Center, Boston, MA;2NYU Medical Center, New York, NY
BACKGROUND:
Mucosal ablation of high-grade dysplasia using RFA is being increasingly reported. RFA for non-dysplastic Barrett’s in combination with an antireflux procedure (ARP) has not been widely documented. We report our initial experience with RFA in association with ARP for Barrett’s metaplasia (BM) and low-grade dysplasia (LGD).
METHODS:
A total of 16 patients (11 male/5 female) presented with BM (n=13) or LGD (n=3). Median age was 58 (38-80) years. Barrett’s severity was classified by length (cm), appearance (circumferential/non-circumferential) and grade (0 = normal, 1= BM, 2 = LGD). RFA was performed using the HALO 360° or 90° systems.
RESULTS:
Median follow-up was 13 months. 13 patients had ARP (4 prior to any ablation). The mean number of ablative procedures undertaken was 2.6 (2-6). There was no mortality. One patient required dilation after treatment. Mean length of Barrett’s decreased from 6.2 to 1.6 cm after treatment (p=0.001). Barrett’s grade decreased significantly (p=0.006) (see figure 1). Prior to therapy, circumferential Barrett’s was present in 14 (87.5%) and non-circumferential Barrett’s in 2 (12.5%). At last endoscopy only one patient had circumferential Barrett’s.
CONCLUSIONS:
RFA is feasible and effective for reducing metaplasia and dysplasia and can be used in association with ARP. Long-term studies will be necessary to determine whether this approach can provide durable control of both reflux and BM.
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