Endoscopic endoluminal radiofrequency ablation of Barrett's esophagus: initial results and lessons learned

Background Ablating Barrett's epithelium may reduce the risk of developing esophageal adenocarcinoma. This study reports the experience of a single surgeon using an endoscopic endoluminal device that delivers radiofrequency energy (the BARRx device) to ablate Barrett's esophagus. Methods All patients who underwent ablation of Barrett's epithelium with the BARRx system were reviewed for length of Barrett's metaplasia, presence of high-grade dysplasia, postprocedure complications, completeness of ablation at first follow-up endoscopy, need for additional ablation, completeness of ablation at second follow-up endoscopy, and concomitant performance of a Nissen fundoplication. Results Sixty-six patients underwent Barrett's ablation. The median length of the Barrett's esophagus was 3 (range, 1-14) cm. Twelve patients (18%) had high-grade dysplasia. There were no immediate procedure-related complications. Four strictures occurred: three in patients with >= 12-cm segments of Barrett's and one in a 6-cm segment. Twenty-nine of 49 patients (59%) who had planned 3-month follow-up endoscopy had complete ablation. Five patients had planned two-stage ablation. Twenty patients with incomplete ablation had additional ablation. Twenty-seven patients had planned follow-up endoscopy at >= 1 year: 25 of 27 ( 93%) had biopsy-proven normal esophageal mucosa. The median length of Barrett's esophagus in patients with initially incomplete ablation was 6 cm, compared with 2 cm in the initially complete ablation patients. Seven Nissen fundoplications were present at the time of ablation, whereas six were performed concomitantly with the ablation without increased difficulty. Conclusions Complete ablation of Barrett's esophagus with radiofrequency endoluminal ablation is achievable in >90% of patients. Patients with longer segments are likely to require additional ablation. Patients with very long segments are at risk for stricture and should be approach cautiously. Performance of a fundoplication is not hindered by concomitant ablation.