Endoscopic radiofrequency ablation (RFA) is an effective treatment for high-grade
dysplasia in Barrett’s esophagus in ablation-naïve patients, but no studies have evaluated
its use in patients in whom ablative therapy has previously failed. We describe 14
patients with residual high-grade dysplasia following aminolevulinic acid or Photofrin
(porfimer sodium) photodynamic therapy (PDT). An overall complete reversal of dysplasia
was achieved in 86 % with a combination of RFA and rescue endoscopic mucosal resection.
The median total follow-up is 19 months. The rate of strictures was 7 % (1/14) and
there was a low rate of buried glands (0.5 % follow-up biopsies). These data suggest
RFA is both safe and effective for eradication of high-grade dysplasia in patients
in whom PDT has failed.
References
1
Overholt B, Lightdale C, Wang K.
Photodynamic therapy (PDT) with porfimer sodium for the ablation of high-grade dysplasia
in Barrett’s esophagus (BE): international, partially blinded randomized phase III
trial.
Gastrointest Endosc.
2005;
62
488-498
2
Overholt B F, Wang K K, Burdick J S et al.
Five-year efficacy and safety of photodynamic therapy with Photofrin in Barrett’s
high-grade dysplasia.
Gastrointest Endosc.
2007;
66
460-468
3
Shaheen N J, Sharma P, Overholt B F et al.
Radiofrequency ablation in Barrett’s esophagus with dysplasia.
N Engl J Med.
2009;
360
2277-2288
4
Sharma V K, Jae K H, Das A et al.
Circumferential and focal ablation of Barrett’s esophagus containing dysplasia.
Am J Gastroenterol.
2009;
104
310-317
5
Ganz R A, Overholt B F, Sharma V K et al.
Circumferential ablation of Barrett’s esophagus that contains high-grade dysplasia:
a U.S. Multicenter Registry.
Gastrointest Endosc.
2008;
68
35-40
6
Gondrie J J, Pouw R E, Sondermeijer C M et al.
Stepwise circumferential and focal ablation of Barrett’s esophagus with high-grade
dysplasia: results of the first prospective series of 11 patients.
Endoscopy.
2008;
40
359-369
7
Mackenzie G D, Dunn J M, Selvasekar C R et al.
Optimal conditions for successful ablation of high-grade dysplasia in Barrett’s oesophagus
using aminolaevulinic acid photodynamic therapy.
Lasers Med Sci.
2009;
24
729-734
8
Sharma P, Dent J, Armstrong D et al.
The development and validation of an endoscopic grading system for Barrett’s esophagus:
the Prague C & M criteria.
Gastroenterology.
2006;
131
1392-1399
9
Lantz H, Vakil N.
Barrett’s esophagus and argon plasma coagulation: buried trouble?.
Am J Gastroenterol.
2003;
98
1647-1649
10
Bronner M P, Overholt B F, Taylor S L et al.
Squamous overgrowth is not a safety concern for photodynamic therapy for Barrett’s
esophagus with high-grade dysplasia.
Gastroenterology.
2009;
136
56-64
11
van Laethem J L, Peny M O, Salmon I et al.
Intramucosal adenocarcinoma arising under squamous re-epithelialisation of Barrett’s
oesophagus.
Gut.
2000;
46
574-577
12
Hornick J L, Blount P L, Sanchez C A et al.
Biologic properties of columnar epithelium underneath reepithelialized squamous mucosa
in Barrett’s esophagus.
Am J Surg Pathol.
2005;
29
372-380
13
Gondrie J J, Pouw R E, Sondermeijer C M et al.
Effective treatment of early Barrett’s neoplasia with stepwise circumferential and
focal ablation using the HALO system.
Endoscopy.
2008;
40
370-379
14
Shaheen N J, Fleischer D E, Eisen G M et al.
Durability of epithelial reversion after radiofrequency ablation: follow-up of the
AIM Dysplasia Trial.
Gastroenterology.
2010;
138 (Suppl 1)
S92
L. LovatMD
National Medical Laser Centre University College London
67 – 73 Riding House Street London W1W 7EJ United Kingdom
Fax: +44-20-78132828
eMail: l.lovat@uclh.nhs.uk