Endoscopic Treatment Could Spare Surgery in Barrett's Esophagus Patients

A new study has found that early tumor formation in Barrett''s esophagus (BE) can be effectively and safely treated with radiofrequency ablation (RFA), in combination with prior endoscopic removal of visible lesions.

Researchers from the University of Amsterdam (UVA; The Netherlands), Evangelisches Krankenhaus (Düsseldorf, Germany), and Erasme University Hospital (Brussels, Belgium) conducted a multicenter, prospective cohort study that included 24 patients (mean age 65), with BE less or equal to 12 cm containing high-grade intraepithelial neoplasia (HGIN) or early cancer.

Visible lesions were endoscopically resected, followed by serial RFA; focal escape endoscopic resection was used if Barrett tissue persisted despite RFA. Complete response, defined as all biopsies negative for intestinal metaplasia and neoplasia, and was assessed during endoscopy with four-quadrant biopsies taken for every one centimeter of the original Barrett's segment, two months after the patient was last treated.

The results showed that of the 23 patients that underwent pre-RFA endoscopic resection for visible lesions, 16 patients had early cancer and seven patients had HGIN. The worst residual histology results, pre-RFA (and after any endoscopic resection) were HGIN (10 patients), low-grade intraepithelial neoplasia (11 patients), and intestinal metaplasia (three patients). Neoplasia and intestinal metaplasia were eradicated in 95% and 88% of patients, respectively; after escape endoscopic resection in two of the patients, rates improved to 100% and 96%, respectively. After additional follow-up for a median period of 22 months, no neoplasia had recurred. The study was published in the January 2010 issue of the journal Clinical Gastroenterology and Hepatology.

"Combining endoscopic resection with complete removal of residual Barrett cells with radiofrequency ablation may decrease the recurrence of lesion formation, and could potentially limit the number of Barrett's esophagus cases that progress to esophageal cancer,” said lead author Jacques Bergman, M.D., of the Academic Medical Center at UVA.

Currently, the cornerstone of treatment of early BE tumors are endoscopic resection in which visible lesions are removed, and tumor infiltration depth and differentiation are assessed. After focal endoscopic resection, however, the residual Barrett mucosa remains at risk for malignant transformation and cancer recurrences are found in 30% of patients during follow-up. To prevent such lesions, newer endoscopic approaches, including RFA, have been studied in an attempt to eradicate the residual Barrett mucosa.

Related Links:
University of Amsterdam
Evangelisches Krankenhaus
Erasme University Hospital