Treatment of Ultra-long Segment Barretts Using Focal and Balloon-based Radiofrequency Ablation

INTRODUCTION: Endoscopic radiofrequency ablation (ERFA) is being evaluated as definitive treatment for patients with Barrett’s esophagus (BE). Guidelines have yet to be developed for the application of this technology to patients with ultra-long segment BE (ULBE, > or = to 8cm). This study reports a single institution’s experience with ERFA of ULBE with various degrees of dysplasia.
METHODS: A retrospective review of all patients undergoing ERFA in our institution from Aug. 2005 to Sept. 2008 was conducted. We identified all patients with BE > or = to 8cm. The entire segment of visible intestinal metaplasia (IM) was treated at each session using ballon-based (HALO-360) and/or plate-based (HALO-90) devices (BARRX Medical, Inc., Sunnyvale, CA, USA). Patient characteristics, clinical/pathologic findings, and treatment history were examined. Re-treatments, endoscopic mucosal resection (EMR), dilations and biopsies were performed based on endoscopic findings. Surveillance was conducted at intervals according to standard guidelines.
RESULTS: Twenty-one patients (18 males, 3 females) with a mean age of 66 years (range 50-85) were included. The average length of BE treated was 10.6 cm (±2.3; range 8-14). Intramucosal carcinoma was present in 3 patients, 14 had high grade dysplasia, 3 had low grade dysplasia and one patient had IM without dysplasia. Complications for all 21 patients included mild self-limited hemorrhage (n=1), stricture (n=2), and nausea and vomiting (n=2). Twelve of the 21 patients have already had post ablation biopsies. One patient was lost to follow up and 8 patients are still in the active treatment phase. Of these patients, 75% (9/12) had a complete response (CR; no residual IM) after 3 (median) ERFA sessions. Mean follow-up time for this cohort was 15.7 months (±9.3). Additional results are summarized in Table 1.

Table 1.
CONCLUSION: ERFA is safe and feasible in patients with ULBE and can applied to the entire length of IM during one session. Eradication of BE (with or without dysplasia) can be achieved with few repeat ablations and continued, vigilant surveillance.

Session: Podium Presentation

Program Number: S069

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