In the current issue of "Clinical Gastroenterology and Hepatology", R.E. Pouw and colleagues authored a report on the efficiency of combining radiofrequency ablation and endoscopic resection in cases of Barrett's esophagus with evidence of early neoplasia. Barrett's esophagus is a condition which results from chronic gastroesophageal reflux disease (GERD). The repeated exposure of stomach acid to the esophagus causes changes in the cell structure. The normal squamous cells transform to glandular cells, similar to those cells which line the stomach and intestines. These cells are more resistant to stomach acid. A diagnosis of Barrett's esophagus increases the risk of developing esophageal cancer.
These researchers conducted a trial at three European medical centers.The subjects were individuals, ages 18 to 85 years old, with Barrett's esophagus. The patients had evidence of high grade intraepithelial neoplasia (HGIN) or early cancer on two endoscopies which were performed six months before the trial began. Intraepithelial neoplasia refers to abnormal or uncontrolled growth of cells within the layers of the organ. To qualify for this study, the patients had to exhibit no evidence of metastasis.
Existing treatment for Barrett's esophagus includes the use of proton pump inhibitors which control gastric acid output and reduce esophageal acid reflux. More advanced cases require invasive treatment such as surgical removal of most of the esophagus or the removal of damaged cells using an endoscope. In recent years, the use of radiofrequency ablation has been used to burn the damaged esophageal tissue. The Halo 90 catheter is attached to the distal end of the endoscope. Electrodes provide controlled energy which the gastroenterologist directs at the damaged tissue.
In this European study, visible esophageal lesions were removed by endoscopic resection. Two follow-up endoscopies with biopsies were performed to detect any remaining cancer. The patients received the proton pump inhibitor, esomeprazole 40 mg twice a day throughout the entire trial and sucralfate suspension and ranitidine 300 mg for two weeks following the endoscopy.