Checkup

Turning Up the Heat

Radiofrequency ablation treats Barrett's esophagus

Dr. Herbert Wolfsen says that radiofrequency ablation is a promising treatment for Barrett's esophagus.

Gastroenterologists at Mayo Clinic are using radiofrequency ablation (RFA) to treat Barrett's esophagus, a condition that leads to esophageal cancer in some people.

Barrett's esophagus is believed to result from the damage chronic acid reflux does to the lining of the esophagus. Over time, normal esophagus cells that are exposed to high levels of acid are replaced with cells like those found lower in the intestines. Some people with the condition go on to develop precancerous changes called dysplasia, which indicates a much higher risk for the development of invasive cancer. Doctors classify dysplasia as either low-grade or high-grade depending on the extent of abnormality within the cells. High-grade dysplasia is also called carcinoma in situ, or surface cancer.

"Most patients who get invasive esophagus cancer will die. It's one of the more lethal cancers," says Mayo Clinic gastroenterologist Dr. Herbert Wolfsen. "But in its precancerous phase, or the high-grade-dysplasia phase, it's highly treatable and, we think, curable."

RFA is preferred for treating certain types of cancers because it can reliably destroy small areas of tissue without affecting surrounding healthy cells. The procedure is more accurate because doctors can better pinpoint the treatment area and control the temperature. During the 30-minute outpatient treatment, a gastroenterologist passes a special endoscope into the patient's esophagus. The endoscope has a tiny balloon at its tip that delivers controlled radiofrequency energy to destroy a thin layer of surface tissue that contains the problem cells. Patients go home hours after the procedure but may expect mild to moderate chest pain and swallowing difficulty for five to seven days.

Until recently, doctors' usual recommendation to patients with Barrett's esophagus and low-grade dysplasia was to undergo a periodic endoscopy to make sure the condition was not getting worse. But Wolfsen says there was never a way to guarantee the patient wouldn't develop cancer between these surveillance endoscopies or have early cancer go undetected. This new treatment is an option for patients who are uneasy with the conventional 'watchful waiting' approach.

"A lot depends on the person," Wolfsen says. "If you're 85 years old and have many other medical problems, this might not be your top concern. On the other hand, if you're 55 years old, in pretty good health and proactive about your health, your approach may be much different."

Wolfsen cautions that since the procedure is still new, there is no conclusive data to show that patients who have RFA for Barrett's esophagus or low-grade dysplasia will never develop cancer. But that risk should be significantly lower if this treatment is as effective as photodynamic therapy, another minimally invasive procedure used to treat patients with high-grade dysplasia.

He adds that RFAis not a treatment for gastroesophageal reflux disease (GERD). Although GERD can lead to Barrett's esophagus, it's still important to address it because RFAis not a treatment that prevents the reflux condition.

Info
Wolfsen and his colleagues are beginning to enroll patients with low-grade dysplasia and select patients with Barrett's esophagus in a multicenter trial to further study the effectiveness of this procedure. Those interested in participating may call (904) 953-2221 for more information.

Learn more about heartburn/GERD on MayoClinic.com.