Radiofrequency Ablation for dysplastic Barrett’s Oesophagus – Beaumont experience
Vikrant Kale, Anwar Syed, Shweta Shinde, Wendy Hickey, Stephen Patchett
Beaumont Hospital, Dublin
Barrett’s oesophagus(BO), a condition of intestinal metaplasia of the oesophagus, is associated with an increased risk of oesophageal adenocarcinoma(OAC), particularly if cellular dysplasia is present. In recent years, management of high grade dysplasia and early mucosal carcinomas has shifted from surgical resection to endoscopic ablation and/or resection. Radiofrequency ablation (RFA) with a circumferential catheter (Halo-360) or tangential catheter (Halo-90) have emerged as the treatment of choice for dysplastic Barrett’s oesophagus without visible mucosal lesions.
We aimed to assess the effectiveness of RFA in eradication of dysplasia in BO in a consecutive series of patients presenting for treatment at a single Irish centre.
We performed retrospective analysis of records of all the patients having undergone RFA(Halo-360) for dysplasia in our institute over last 5years. The indications for RFA and subsequent endoscopy reports and pathology results were reviewed and recorded. End points were complete eradication of dysplasia(CED) and complete eradication of intestinal metaplasia(CEIM).
Over the study period, RFA(Halo-360) was done for 19 patients. One patient had a stroke and no subsequent follow up and another patient had squamous dysplasia. These two patient were excluded from analysis. Records for 17 patients (15 males/ 2 females) were reviewed and analysed. Average age was 66yrs (37 – 85yrs). Primary indications for RFA were high grade dysplasia and/or intramucosal adenocarcinoma. Patients were followed up for minimum of 6months. Follow up RFA with Halo-90 was required in 13 patients with a mean number of procedures per patient being 2 (0-5). CED was achieved in 12 out of 17 patients (71%) and CEIM was achieved in 10 out of 17 patients (56%). Out of five patients who didn’t achieve CED, 2 patients had oesophagectomy and the other 3 were deemed unfit for surgery and had palliative procedures done.
RFA for HGD and early OAC is an effective treatment option. Our results are comparable to published rates of successful eradication of dysplasia in BO overall. Results were better in the last 2 years with the learning curve effect.