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RADIOFREQUENCY ABLATION FOR BARRETT’S ESOPHAGUS WITH DYSPLASIA AND ESOPHAGEAL INTRAMUCOSAL ADENOCARCINOMA: THE ALBERTA EXPERIENCE
A Morse1, C Nash2, C Bentz1, C Turbide2, P Krongold2, C Wong1
1University of Alberta, Edmonton; 2University of Calgary, Calgary, Alberta
Aims: Esophageal adenocarcinoma has the highest rate of increasing incidence amongst all cancers in Western nations. The approach to management of Barrett's esophagus with high-grade dysplasia and intramucosal neoplasias is evolving rapidly. This is largely due to the development of endoscopic therapies like endoscopic mucosal resesection (EMR) and muscosal ablative therapies such as radiofrequency ablation (RFA) and photodynamic therapy (PDT). Non-operative management strategies are important, as patients may have contraindications for esophagectomy or choose not to have surgery.
Methods: This case series reviews the treatment of esophageal dysplasia or intramucosal adenocarcinoma where RFA was either used either alone or in conjunction with PDT and EMR.
Results: A total of 7 cases where RFA was used for Barrett's esophagus with dysplasia or esophageal intramucosal adenocarcinoma in tertiary care centres in Alberta were reviewed. RFA was administered via a novel, circumferential balloon based or pad based technology. Four cases showed histological regression of disease (e.g., high grade dysplasia to Barrett's esophagus no dysplasia). The remaining cases had no histological progression of disease, but still showed no regression at this stage of their treatment regimens. Follow-up data represents a range of 4 weeks to 6 months (median 6 months). Fifty-six percent of cases involved required multiple treatment sessions and 2 cases required PDT and EMR in addition to RFA. There were no reported complications.
Conclusions: Endoscopic therapy for Barrett's esophagus and early esophageal adenocarcinoma is rapidly evolving. The Alberta experience with RFA to date, reveals that histologic regression of dysplastic Barrett's esophagus or early carcinoma is achievable. Multiple treatment modalities and multiple treatment sessions may be required. Endoscopic ablation does not remove the need for rigorous surveillance. Long-term studies and data are still required.