Endoscopy 2011; 43(7): 627-630
DOI: 10.1055/s-0030-1256443
Case report/series

© Georg Thieme Verlag KG Stuttgart · New York

Radiofrequency ablation is effective for the treatment of high-grade dysplasia in Barrett’s esophagus after failed photodynamic therapy

J.  M.  Dunn1 , M.  R.  Banks2 , D.  Oukrif3 , G.  D.  Mackenzie1 , S.  Thorpe1 , M.  Rodriguez-Justo3 , A.  Winstanley3 , S.  G.  Bown1 , M.  R.  Novelli3 , L.  B.  Lovat1 , 2
  • 1National Medical Laser Centre, Department of Surgery, University College London, London, UK
  • 2Department of Gastroenterology, University College London Hospitals NHS Foundation Trust, London, UK
  • 3Department of Histopathology, University College London, London, UK
Further Information

Publication History

submitted 22 June 2010

accepted after revision 31 January 2011

Publication Date:
29 June 2011 (online)

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