Endoscopy 2015; 47(07): 592-597
DOI: 10.1055/s-0034-1391436
Original article
© Georg Thieme Verlag KG Stuttgart · New York

Simplified protocol for focal radiofrequency ablation using the HALO90 device: short-term efficacy and safety in patients with dysplastic Barrett’s esophagus

Hannah T. Künzli
1   Department of Gastroenterology and Hepatology, St. Antonius Hospital, Nieuwegein, The Netherlands
2   Department of Gastroenterology and Hepatology, Academic Medical Center Amsterdam, The Netherlands
,
Dirk W. Schölvinck
1   Department of Gastroenterology and Hepatology, St. Antonius Hospital, Nieuwegein, The Netherlands
2   Department of Gastroenterology and Hepatology, Academic Medical Center Amsterdam, The Netherlands
,
K. Nadine Phoa
2   Department of Gastroenterology and Hepatology, Academic Medical Center Amsterdam, The Netherlands
,
Erik J. Schoon
3   Department of Gastroenterology, Catharina Hospital Eindhoven, The Netherlands
,
Martin H. Houben
4   Department of Gastroenterology, Haga Hospital the Hague, The Netherlands
,
Jacques J. G. H. M. Bergman
2   Department of Gastroenterology and Hepatology, Academic Medical Center Amsterdam, The Netherlands
,
Bas L. A. M. Weusten
1   Department of Gastroenterology and Hepatology, St. Antonius Hospital, Nieuwegein, The Netherlands
2   Department of Gastroenterology and Hepatology, Academic Medical Center Amsterdam, The Netherlands
› Author Affiliations
Further Information

Publication History

submitted10 July 2014

accepted after revision27 November 2014

Publication Date:
12 February 2015 (online)

Also available at
    Permissions and Reprints

See also:

Commentaire du travail de Künzli HT et al., pp. 592Endoscopy 2015; 47(07): 665-665
DOI: 10.1055/s-0035-1547140

Background and study aims: The standard protocol for focal radiofrequency ablation (RFA) of Barrett’s esophagus comprises two applications of radiofrequency energy, cleaning of the ablated areas and catheter, and two further applications (2 × 15 J/cm2 – cleaning – 2 × 15 J/cm2). A simplified protocol (3 × 15 J/cm2, no cleaning) proved noninferior to standard protocol for individual islands of Barrett’s esophagus, but may be associated with higher stenosis rates when applied circumferentially and sequentially over time. We evaluated the efficacy and safety of the abovementioned simplified protocol.

Patients and methods: Barrett’s esophagus patients undergoing focal RFA using the simplified protocol in four tertiary referral centers were retrospectively included. During each focal ablation, the gastroesophageal junction (GEJ) was ablated circumferentially in addition to Barrett’s esophagus islands or tongues. Sessions continued at 8 to 12-week intervals until complete resolution of Barrett’s esophagus. Primary outcome parameters comprised complete remission of dysplasia and of intestinal metaplasia, and stenosis requiring dilation.

Results: 83 patients with dysplastic Barrett’s esophagus (median Prague classification C1M3) were enrolled; 66/83 (80 %) had endoscopic resection of a visible lesion before RFA. Intention-to-treat analysis showed complete remission of dysplasia in 78/83 (94 %) and of intestinal metaplasia in 72/83 (87 %). Stenosis requiring dilation developed in 9/83 (11 %), necessitating a median 2 dilation sessions (range 1 – 9), with ≥ 8 sessions in three patients.

Conclusion: A treatment algorithm incorporating the simplified protocol of 3 × 15 J/cm2, with no cleaning, for all focal RFA sessions, appears effective. The associated number and severity of stenoses, however, raises safety concerns.

 

  • References

  • 1 Shaheen NJ, Sharma P, Overholt BF et al. Radiofrequency ablation in Barrett’s esophagus with dysplasia. N Engl J Med 2009; 360: 2277-2288
    CrossrefPubMedGoogle Scholar
  • 2 Van Vilsteren FGI, Pouw RE, Seewald S et al. Stepwise radical endoscopic resection versus radiofrequency ablation for Barrett’s oesophagus with high-grade dysplasia or early cancer: a multicentre randomised trial. Gut 2011; 60: 765-773
    CrossrefPubMedGoogle Scholar
  • 3 Pouw RE, Wirths K, Eisendrath P et al. Efficacy of radiofrequency ablation combined with endoscopic resection for barrett’s esophagus with early neoplasia. Clin Gastroenterol Hepatol 2010; 8: 23-29
    CrossrefPubMedGoogle Scholar
  • 4 Fleischer DE, Overholt BF, Sharma VK et al. Endoscopic radiofrequency ablation for Barrett’s esophagus: 5-year outcomes from a prospective multicenter trial. Endoscopy 2010; 42: 781-789
    Article in Thieme ConnectPubMedGoogle Scholar
  • 5 Phoa KN, Pouw RE, van Vilsteren FGI et al. Remission of Barrett’s esophagus with early neoplasia 5 years after radiofrequency ablation with endoscopic resection: a Netherlands cohort study. Gastroenterology 2013; 145: 96-104
    CrossrefPubMedGoogle Scholar
  • 6 Shaheen NJ, Overholt BF, Sampliner RE et al. Durability of radiofrequency ablation in Barrett’s esophagus with dysplasia. Gastroenterology 2011; 141: 460-468
    CrossrefPubMedGoogle Scholar
  • 7 Pouw RE, Gondrie JJ, Rygiel AM et al. Properties of the neosquamous epithelium after radiofrequency ablation of Barrett’s esophagus containing neoplasia. Am J Gastroenterol 2009; 104: 1366-1373
    CrossrefPubMedGoogle Scholar
  • 8 Van Vilsteren FGI, Phoa KN, Alvarez Herrero L et al. A simplified regimen for focal radiofrequency ablation of Barrett mucosa: a randomized multicenter trial comparing two ablation regimens. Gastrointest Endosc 2013; 78: 30-38
    CrossrefPubMedGoogle Scholar
  • 9 Sharma P, Dent J, Armstrong D et al. The development and validation of an endoscopic grading system for Barrett’s esophagus: the Prague C & M criteria. Gastroenterology 2006; 131: 1392-1399
    CrossrefPubMedGoogle Scholar
  • 10 Van Vilsteren FGI, Bergman JJGHM. Endoscopic therapy using radiofrequency ablation for esophageal dysplasia and carcinoma in Barrett’s esophagus. Gastrointest Endosc Clin N Am 2010; 20: 55-74
    CrossrefPubMedGoogle Scholar
  • 11 Peters FP, Brakenhoff KPM, Curvers WL et al. Histologic evaluation of resection specimens obtained at 293 endoscopic resections in Barrett’s esophagus. Gastrointest Endosc 2008; 67: 604-609
    CrossrefPubMedGoogle Scholar
  • 12 Schlemper RJ, Riddell RH, Kato Y et al. The Vienna classification of gastrointestinal epithelial neoplasia. Gut 2000; 47: 251-255
    CrossrefPubMedGoogle Scholar
  • 13 Pouw RE, Seewald S, Gondrie JJ et al. Stepwise radical endoscopic resection for eradication of Barrett’s oesophagus with early neoplasia in a cohort of 169 patients. Gut 2010; 59: 1169-1177
    CrossrefPubMedGoogle Scholar
  • 14 Dunkin BJ, Martinez J, Bejarano PA et al. Thin-layer ablation of human esophageal epithelium using a bipolar radiofrequency balloon device. Surg Endosc 2006; 20: 125-130
    CrossrefPubMedGoogle Scholar
  • 15 Ganz RA, Utley DS, Stern RA et al. Complete ablation of esophageal epithelium with a balloon-based bipolar electrode: a phased evaluation in the porcine and in the human esophagus. Gastrointest Endosc 2004; 60: 1002-1010
    CrossrefPubMedGoogle Scholar
  • 16 Smith CD, Bejarano PA, Melvin WS et al. Endoscopic ablation of intestinal metaplasia containing high-grade dysplasia in esophagectomy patients using a balloon-based ablation system. Surg Endosc 2007; 21: 560-569
    CrossrefPubMedGoogle Scholar
  • 17 Fleischer DE, Overholt BF, Sharma VK et al. Endoscopic ablation of Barrett’s esophagus: a multicenter study with 2.5-year follow-up. Gastrointest Endosc 2008; 68: 867-876
    CrossrefPubMedGoogle Scholar
  • 18 Gondrie JJ, Pouw RE, Sondermeijer CM et al. Stepwise circumferential and focal ablation of Barrett's esophagus with high-grade dysplasia: results of the first prospective series of 11 patients. Endoscopy 2008; 40: 359-369
    Article in Thieme ConnectPubMedGoogle Scholar
  • 19 Gondrie JJ, Pouw RE, Sondermeijer CMT et al. Effective treatment of early Barrett’s neoplasia with stepwise circumferential and focal ablation using the HALO system. Endoscopy 2008; 40: 370-379
    Article in Thieme ConnectPubMedGoogle Scholar
  • 20 Van Vilsteren FGI, Phoa KN, Herrero LA et al. Circumferential balloon-based radiofrequency ablation of Barrett’s esophagus with dysplasia can be simplified, yet efficacy maintained, by omitting the cleaning phase. Clin Gastroenterol Hepatol 2013; 11: 491-498
    CrossrefPubMedGoogle Scholar
  • 21 Phoa KN, Pouw RE, Bisschops R et al. Radiofrequency ablation combined with endoscopic resection is highly effective for eradication of early Barrett’s neoplasia: Final results from a large prospective European multicenter study (EURO-II). Gastrointest Endosc 2013; 77: AB 137
    PubMedGoogle Scholar
  • 22 Bulsiewicz WJ, Kim HP, Dellon ES et al. Safety and efficacy of endoscopic mucosal therapy with radiofrequency ablation for patients with neoplastic barrett’s esophagus. Clin Gastroenterol Hepatol 2013; 11: 636-642
    CrossrefPubMedGoogle Scholar
  • 23 Orman ES, Li N, Shaheen NJ. Efficacy and durability of radiofrequency ablation for Barrett’s Esophagus: systematic review and meta-analysis. Clin Gastroenterol Hepatol 2013; 11: 1245-1255
    CrossrefPubMedGoogle Scholar
  • 24 Pouw RE, Gondrie JJ, Sondermeijer CM et al. Eradication of Barrett esophagus with early neoplasia by radiofrequency ablation, with or without endoscopic resection. J Gastrointest Surg 2008; 12: 1627-1636 discussion 1636–1637
    CrossrefPubMedGoogle Scholar
  • 25 Sharma VK, Wang KK, Overholt BF et al. Balloon-based, circumferential, endoscopic radiofrequency ablation of Barrett’s esophagus: 1-year follow-up of 100 patients. Gastrointest Endosc 2007; 65: 185-195
    CrossrefPubMedGoogle Scholar
  • 26 Phoa KN, van Vilsteren FGI, Weusten BLAM et al. Radiofrequency ablation vs endoscopic surveillance for patients with Barrett esophagus and low-grade dysplasia. JAMA 2014; 311: 1209-1217
    CrossrefPubMedGoogle Scholar