Gastroenterologists use radiofrequency ablation to treat Barrett's esophagus

Wednesday, February 08, 2006

JACKSONVILLE, Fla. — Gastroenterologists at Mayo Clinic are using radiofrequency ablation to treat Barrett's esophagus, a premalignant condition that leads to esophageal cancer in some people.

The minimally invasive treatment is an outpatient procedure that takes about 30 minutes. A gastroenterologist specializing in diseases of the esophagus 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.

Barrett's esophagus is believed to result from the damage chronic acid reflux does to the lining of the esophagus. However, many patients do not experience the classic heartburn or regurgitation symptoms. Normal esophagus cells are replaced with cells like those found lower down in the intestines. Some people with Barrett's esophagus go on to develop cancerous changes called dysplasia. Dysplasia means that the size, shape and organization of cells lining the esophagus change, indicating 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. Its 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."

Until recently, doctors' usual recommendation to patients with Barrett's esophagus and low-grade dysplasia was to have a periodic endoscopy performed 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 radiofrequency ablation 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, ablative procedure used to treat patients with high-grade dysplasia.

A final caveat Wolfsen gives is that radiofrequency ablation is not a treatment for gastroesophageal reflux disease (GERD). Though GERD can lead to Barrett's esophagus, it's still important to address GERD; it does not go away because a person had radio frequency ablation.

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.

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