Radiofrequency ablation effective against Barrett esophagus
(12 June 2009: VIDYYA MEDICAL NEWS SERVICE) -- About 10 percent of the 10 million adults in the United States who have chronic gastroesophageal reflux disease develop abnormal cell changes in the lining of their esophagus, a condition called Barrett esophagus (BE) that can lead to esophageal cancer. While 99 percent of adults with BE will not progress to cancer, their risk of developing esophageal cancer is still 100 times greater than that of the general population.
New results published May 27 in the New England Journal of Medicine show that radiofrequency ablation (RFA) may be an effective treatment for BE. Dr. Nicholas J. Shaheen, of the University of North Carolina at Chapel Hill, and his colleagues conducted a trial of 127 BE patients who had either high- or low-grade dysplasia (abnormal cells with precancerous traits) in the lining of their esophagus.
Eighty-four of these patients received the RFA treatment, which involved inserting and then inflating a balloon into the esophagus in an outpatient procedure. Radiofrequency waves heated coils on the balloon’s surface to burn away only the layer of affected cells on the esophageal lining. The remaining 43 patients were part of a control group that received a “sham procedure.”
Low-grade dysplasia was completely eradicated in 90.5 percent of those receiving RFA, compared with 22.7 percent in the control group. High-grade dysplasia was eradicated in 81 percent of those receiving RFA, compared with 19 percent of controls. While RFA had side effects—transient chest discomfort and occasional narrowing of the esophagus—these were slight compared with those of esophagectomy, a treatment commonly used to treat high-grade dysplastic BE, which has a 3 to 5 percent mortality rate and complications in 40 to 50 percent of patients.
In an accompanying editorial, Dr. Jacques J.G.H.M. Bergman of the Academic Medical Center in Amsterdam said these results “suggest that surgery for high-grade dysplasia should no longer be offered routinely.”
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