Ablation Found Effective in Treatment of Barrett's Esophagus

Monday, June 08, 2009

SCOTTSDALE, Ariz. — Promising news for patients with dysplastic Barrett's esophagus: A recent study found a high rate of complete eradication of the disease — and its potential for progressing — in patients who underwent a procedure called radio frequency ablation.

In the radiofrequency ablation procedure, a balloon-like device covered with electrodes — the HALO 360, developed by BARRX Medical — is inserted and inflated, bringing the electrodes in contact with the lining of the esophagus. A pre-set amount of energy is delivered in repeat motions, eradicating the diseased tissue.

Dysplastic, or pre-cancerous lesions, can lead to esophageal cancer. Radiofrequency ablation is a procedure that uses high-intensity radio waves to zap the lesions.

Approximately 10 percent of people with chronic reflux disease (an uncomfortable condition when the contents of the stomach can "reflux," or flow back into the esophagus) have Barrett's esophagus, which is associated with an increased risk of esophageal cancer. Barrett's esophagus, also called intestinal metaplasia in its earliest stage, can progress to low-grade dysplasia and then to high-grade dysplasia and then to cancer.

Co-authors of the study, which was published in the May 28 issue of the New England Journal of Medicine, were David E. Fleischer, M.D., and Virender K. Sharma, M.D., Gastroenterology, at Mayo Clinic in Arizona. In the multi-center trial, 127 patients with dysplastic Barrett's esophagus received either radiofrequency ablation or a controlled procedure. Sixty-four patients had low-grade dysplasia, and 63 had high-grade. In all, 84 patients were assigned to the ablation group and 43 to the control group.

At the conclusion of the 12-month trial, complete eradication of dysplasia was observed in 90.5 percent of those with low-grade dysplasia, compared with 22.7 percent in the control group. Among patients with high-grade dysplasia, complete eradication occurred in 81 percent of those patients in the ablation group, compared with 19 percent of those in the control group.

Participants in the randomized trial ranged in age from 18 to 80 and were recruited for study at 19 medical centers in the U.S., including Mayo Clinic, for the year-long study.

A key outcome of the study was that regardless of the degree of dysplasia, patients who received radiofrequency ablation were significantly more likely to achieve complete eradication of dysplasia than those in the control group.

"These are compelling results for patients with dysplastic Barrett's lesions," noted Dr. Fleischer. "Although more study is warranted, we are encouraged about the results for patients with Barrett's who have advanced beyond the initial stage."

The incidence of esophageal cancer has increased more than 500 times since 1970, making its rise greater than any cancer in the U.S. Esophageal cancer is said to have a five-year survival rate of less than 15 percent, and the key to reducing the mortality is discovering precancerous conditions like dysplasia in Barrett's and treating it early.

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Mayo Clinic is the first and largest integrated, not-for-profit group practice in the world. As a leading academic medical center in the Southwest, Mayo Clinic focuses on providing specialty and surgical care in more than 65 disciplines at its outpatient facility in north Scottsdale and at Mayo Clinic Hospital. The 244-licensed bed hospital is located at 56th Street and Mayo Boulevard (north of Bell Road) in northeast Phoenix, and provides inpatient care to support the medical and surgical specialties of the clinic, which is located at 134th Street and Shea Boulevard in Scottsdale.

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About Mayo Clinic

Mayo Clinic is the first and largest integrated, not-for-profit group practice in the world. Doctors from every medical specialty work together to care for patients, joined by common systems and a philosophy of "the needs of the patient come first." More than 3,700 physicians, scientists and researchers, and 50,100 allied health staff work at Mayo Clinic, which has campuses in Rochester, Minn; Jacksonville, Fla; and Scottsdale/Phoenix, Ariz.; and community-based providers in more than 70 locations in southern Minnesota., western Wisconsin and northeast Iowa. These locations treat more than half a million people each year. To obtain the latest news releases from Mayo Clinic, go to www.mayoclinic.org/news. For information about research and education, visit www.mayo.edu. MayoClinic.com (www.mayoclinic.com) is available as a resource for your health stories.