Endoscopic radiofrequency ablation (HALO-RFA) of the metaplastic mucosa in patients with Barrett's esophagus. The first Hungarian experience

Introduction: Barrett's esophagus is the precancerous lesion of esophageal adenocarcinoma. If dysplasia is present the risk for developing a cancer is further increased. Since medical therapies can only slow down the progression, and the conventional ablative techniques (mucosectomy, argon plasma coagulation) have well known limitations (buried glands, stricture formation) new methods are needed to stop the histological progression and to restore the physiological squamous lining of the esophagus. Initial experiences with the recently developed HALO-RFA seem to provide superior results compared to the conventional techniques.

The aim of our study was to test the efficacy of HALO-RFA in patients with Barrett's esophagus and low grade dysplasia.

Methods: Four patients (M/F 2/2) were enrolled. The maximal lengths of the metaplastic mucosal segments were 4, 5, 7, and 11cm-s. Depending on the lengths of the residual mucosa, the initial HALO 360 procedure was followed by either a second HALO 360 or a HALO 90 procedure 3 months later. Follow up endoscopies with histological sampling were performed at 3 and 6 months after the second procedure to obtain data on the eradication of dysplasia and specialized intestinal metaplasia (SIM).

Results: The initial HALO 360 procedure was followed by a second HALO 90 intervention in the 3 cases with the shorter segment metaplasia and by a HALO 360 ablation in the one with the longest. No complications were observed after the HALO 90 procedures, while minor adverse events (transient chest pain) were seen in 2/4 patients after HALO 360 ablation. No major complications (bleeding, perforation, stricture formation) occurred. The eradication of dysplasia was achieved in all cases (100%). SIM eradication was complete in 1 patient, while 2 further patients had small (<5mm) residual SIM segments. No buried glands were observed during follow up.

Conclusions: Radiofrequency ablation is a safe and reliable procedure for the eradication of esophageal metaplasia and dysplasia. In accord with the international reports, our initial experience support that patients with longer metaplastic segments need more than 2 sessions to achieve complete eradication.

Grant support: TÁMOP421/B09/1, Micromedical Kft, Barrx Ltd.