For the development of esophageal cancer Barrett’s esophagus (BE) is probably known to be one of the key factors. Now a new study suggests that early tumor formation in BE could be effectively and safely treated with radiofrequency ablation (RFA). This in combination with earlier endoscopic removal of visible lesions should spare patients from surgery.
Doctors investigated both the efficacy and safety of this new combined modality approach in this European multi-center, prospective cohort study. They evaluated 23 BE patients with high-grade intraepithelial neoplasia or early cancer. Of these seven patients were in the former group while 16 patients were part of the latter group.
Reportedly removal of tumors and abnormal intestinal cells was attained in nearly 95 percent and 88 percent of the patients respectively. Seemingly post additional escape endoscopic resection in two patients, the scientists achieved 100 percent and 96 percent of patients respectively.
“Barrett’s esophagus is the most important risk factor for the development of esophageal cancer, but there is no generally accepted management strategy for patients with early neoplasia in Barrett’s esophagus,” mentioned Jacques J.G. H. M. Bergman, MD, of the Academic Medical Center and lead author of the study. “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.”
“Selection of Barrett’s esophagus patients for endoscopic treatment involves thorough endoscopic work-up, the possibility to safely perform endoscopic resection and accurate histological evaluation of tissue specimens for the presence of risk factors for disease spread,” further added Dr. Bergman. “Patients in our study received care in highly specialized centers, making it difficult to extrapolate the high reported safety and effectives to all medical centers. We believe the use of radiofrequency ablation for Barrett’s esophagus should be centralized in multi-disciplinary centers with this expertise.”
After RFA some complications observed included melena which is dark tarry stool and difficulty in swallowing. No neoplasia was found to have recurred after additional follow-up. Presently, endoscopic resection is known to be the cornerstone of treatment of early BE tumors. The procedure includes removal of visible lesions and tumor infiltration depth along with assessing the differentiation.
However, after focal endoscopic resection, the residual Barrett mucosa seems to remain at risk for malignant transformation. During follow-up cancer recurrences are reportedly observed in approximately 30 percent of patients. In order to avoid such lesions, endoscopic approaches have been analyzed with intentions to eradicate the residual Barrett mucosa. According to the experts, the newer endoscopic ablation technique namely RFA seems to hold promising safety and efficacy results.
The results feature in Clinical Gastroenterology and Hepatology, the official journal of the American Gastroenterological Association (AGA) Institute.