Heat procedure may reverse Barrett’s oesophagus

MedWire News: Results of a US suggest that a procedure called radiofrequency ablation, which uses targeted thermal energy, is effective for the treatment for Barrett's oesophagus, helping reduce patients’ risk of developing cancer of the oesophagus.

Patients with long-term gastro-oesophageal reflux disease have an increased risk of developing Barrett's oesophagus, a potentially pre-cancerous condition in which the lining of the oesophagus becomes damaged by stomach acid and starts to resemble that found in the stomach.

“The current standard of care for patients with Barrett's esophagus has been watchful waiting or surveillance – delaying surgery until the first sign of cancer,” explained co-researcher Dr Charles Lightdale, from Columbia University Medical Center in New York, USA.

As radiofrequency ablation has proved effective at treating a variety of other tissue conditions, the researchers investigated whether the procedure can reverse the oesophageal tissue changes that are characteristic of Barrett’s oesophagus, therefore helping to prevent disease progression to oesophageal cancer.

Radiofrequency ablation for Barrett's oesophagus is a half-hour outpatient procedure performed under mild sedation. The energy is highly controlled, and can be limited to the thin layer of the oesophagus, preventing injury to healthy tissue.

The team studied 127 patients with Barrett's esophagus who were divided into two groups. One group received radiofrequency ablation and the other group received a sham procedure followed by watchful waiting. All the patients were monitored for 12 months.

At the end of the 12-month period, the researchers found that 77.4% of patients who received radiofrequency ablation no longer had abnormal oesophageal tissue (dysplasia), compared with just 2.3% of patients in the other group.

For patients with small amounts of dysplasia, complete eradication occurred in 90.5% of the radiofrequency ablation group compared with 22.7% of the other group. For patients with more advanced, "high grade" dysplasia, complete eradication occurred in 81.0% of the ablation group, compared with 19.0% of the other group.

Furthermore, only 1.2% of patients who received radiofrequency ablation developed oesophageal cancer, compared with 9.3% of the other patients.

Lead researcher Dr Nicholas Shaheen (University of North Carolina School of Medicine, Chapel Hill) and team conclude in the New England Journal of Medicine: “In patients with dysplastic Barrett's esophagus, radiofrequency ablation was associated with a high rate of complete eradication of both dysplasia and intestinal metaplasia and a reduced risk of disease progression.”

Dr Lightdale added: “This study offers powerful evidence that treatment using radiofrequency ablation can help prevent esophageal cancer by completely reversing overall Barrett's esophagus and its more severe tissue changes, or dysplasias.”