Monday, September 27, 2010
SCOTTSDALE, Ariz. — Barrett's esophagus (BE), a condition that can lead to esophageal cancer, can often be eliminated by using radiofrequency ablation (RFA), according to a new Mayo Clinic study. Findings reveal that most patients remain free of BE five years following the initial procedure. These findings provide an alternative to the current recommendations of constant surveillance of BE for risk of progression into esophageal cancer in appropriate patients.
About one in 200 patients with the earliest form of Barrett's develops esophageal cancer each year. The incidence of esophageal cancer is increasing more rapidly than any other cancer in the U.S.
In this prospective, multicenter trial, conducted between May 2004 and November 2009, researchers performed endoscopic RFA in 50 patients with intestinal metaplasia. RFA is designed to burn away layers of the abnormal Barrett's cells. Results showed that 46 of the 50 remained free of BE. Four patients had low levels of residual disease that was eliminated in a single RFA session.
"We've shown that by treating patients with early Barrett's we were able to get rid of the disease in most instances, and we hope that will lead to a reduction in the cancer associated with it," said David Fleischer, M.D., Gastroenterology and Hepatology at Mayo Clinic in Arizona. "RFA represents a durable, long-term approach to treating Barrett's esophagus and restoring cells to normal."
BE is a complication of acid reflux that affects mostly Caucasian males over age 50. BE occurs when the esophagus is burned by stomach acid, causing normal cells to convert to cells resembling those from the stomach or intestine. Normally this disease progresses in stages: from the initial stage of metaplasia to low grade dysplasia, high grade dysplasia and cancer. National recommendations for BE in its earliest stages suggest monitoring the disease progression with regular endoscopies.
Dr. Fleischer points out that there are some limitations to surveillance for patients with Barrett's. Surveillance as a primary strategy has not been shown to be cost-effective. Some patients who have followed recommended surveillance strategies are diagnosed with esophageal carcinoma despite undergoing surveillance. In addition, recommendations assume that the endoscopist takes the requisite number of biopsies, and information suggests that the biopsies are not always taken.
Dr. Fleischer and colleagues will continue to follow patients to assess continued durability of the procedure. He cautioned that no therapy is perfect, but RFA technology is exciting and the results to date are encouraging.
Results of the study were described in the August 2010 edition of Gi & Hepatology News. and the full manuscript will be published in Endoscopy next month.
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