Management of Barrett Esophagus Following Radiofrequency Ablation

Abstract

Radiofrequency ablation (RFA) effectively treats dysplastic Barrett esophagus (BE), reduces the risk of esophageal adenocarcinoma (EAC), and infrequently produces complications. Complications of RFA include chest discomfort, esophageal stricturing, and bleeding. However, chest discomfort is usually transient and mild, strictures are generally amenable to dilation, and clinically significant bleeding is rare. Following RFA, intestinal metaplasia recurs at a rate of approximately 10% per patient year of follow-up time. Postablation dysplastic BE and EAC are rare. Moreover, recurrent disease is generally responsive to further endoscopic therapy and is associated with a benign clinical course. Although RFA is effective at producing low rates of postablation EAC and dysplastic recurrence, data suggest that current consensus guidelines for postablation surveillance are overly aggressive, as they mirror those for treatment-naive cohorts. Future guidelines may attenuate surveillance intervals, reducing the burden of endoscopic surveillance while providing for adequate detection of recurrent disease. Additional studies are needed to determine the length of time patients should ultimately remain in surveillance programs. Uncertainty exists regarding the appropriate application of chemopreventive measures (including proton pump inhibitors, aspirin, and statins) and novel imaging and sampling modalities (such as optical coherence tomography and wide-area transepithelial sampling) to reduce the risk of recurrent disease and sampling error, respectively. These uncertainties represent targets for future investigations.

Keywords: Barrett esophagus; complications; durability; dysplasia; radiofrequency ablation.

Figure 1.

Kaplan-Meier plot of intestinal metaplasia recurrence among patients who achieved complete eradication of intestinal metaplasia (CEIM) after radiofrequency ablation (n=1634). Modified with permission from Pasricha S et al.

Figure 2.

Kaplan-Meier plot of intestinal metaplasia recurrence among patients who achieved complete eradication of intestinal metaplasia (CEIM) after radiofrequency ablation, with pretreatment histology of nondysplastic Barrett esophagus (BE), indefinite for dysplasia, low-grade dysplasia (LGD), high-grade dysplasia (HGD), and intramucosal carcinoma (IMC). Modified with permission from Pasricha S et al.