Endoscopic Endoluminal Radiofrequency Ablation of Barrett’s Esophagus: Initial Results and Lessons Learned

Background: Ablating Barrett’s epithelium may reduce the risk of developing esophageal adenocarcinoma. This study reports the initial experience of a single surgeon using an endoscopic endoluminal device delivering radiofrequency energy (the BARRx device) in ablating Barrett’s esophagus.
Methods: All patients who underwent ablation of Barrett’s epithelium with the BARRx system were reviewed for length of Barrett’s metaplasia, presence of high-grade dysplasia, postprocedure complication, completeness of ablation at first follow-up endoscopy (3 months after ablation), need for additional ablation, completeness of ablation at second follow-up endoscopy (6 to 12 months after ablation), and concomitant performance of a Nissen fundoplication.
Results: 47 patients underwent Barrett’s ablation. A total of 59 ablations were done in these patients. The median length of the Barrett’s esophagus was 3 cm (range: 1-14 cm). 8 patients (17%) had high-grade dysplasia. There were no immediate complications. 25 of 36 patients (69%) who had follow-up endoscopy had complete ablation. 11 patients with incomplete ablation had additional ablation, and 10 of these patients (91%) had complete ablation on second follow-up. One patient (Barrett’s esophagus length of 12 cm) had 3 ablations, but continued to have residual metaplasia. Therefore, 97% of the total cohort had complete ablation. The median length of Barrett’s esophagus in patients with initially incomplete ablation was 8 cm (range: 2-14), compared to 2 cm (range: 1-13) in the initially complete ablation patients. 7 of 8 patients with high grade dysplasia had complete ablation identified in the first follow-up endoscopy. 3 strictures occurred, all in patients with >12 cm segments of Barrett’s. 10 Nissen fundoplications were done concomitantly with the ablation, without increased difficulty.
Conclusions: Complete ablation of Barrett’s esophagus with radiofrequency endoluminal ablation is achievable in >95% of patients. Patients with longer segments are likely to require additional ablation. Patients with very long segments are at risk for stricture, and should be approach cautiously. Performance of a fundoplication is not hindered by concomitant ablation.

Session: Podium Presentation

Program Number: S063