Endoscopic radiofrequency ablation combined with endoscopic resection for early neoplasia in Barrett's esophagus longer than 10 cm

Background: Radiofrequency ablation (REA) is safe and effective for eradicating Barrett's esophagus (BE) and BE-associated early neoplasia. Most REA studies have limited the baseline length of BE (<10 cm), and therefore little is known about REA for longer BE. Objective: To assess the safety and efficacy of RFA with or without prior endoscopic resection (ER) for BE >= 10 ern containing neoplasia. Design: Prospective trial. Setting: Two tertiary-care centers. Patients: This study involved consecutive patients with BE >= 10 cm with early neoplasia. Intervention: Focal ER for visible abnormalities, followed by a maximum of 2 circumferential and 3 focal REA procedures every 2 to 3 months until complete remission. Main Outcome Measurements: Complete remission, defined as endoscopic resolution of BE and no intestinal metaplasia (CR-IM) or neoplasia (CR-neoplasia) in biopsy specimens. Results: Of the 26 patients included, 18 underwent ER for visible abnormalities before RFA. The ER specimens showed early cancer in 11, high-grade intraepithelial neoplasia (HGIN) in 6, and low-grade intraepithelial neoplasia (LGIN) in 1. The worst residual histology, before RFA and after any ER, was HGIN in 16 patients and LGIN in 10 patients. CR-neoplasia and CR-IM were achieved in 83% (95% confidence interval [CI], 63%-95%) and 79% (95% CI, 58%-93%), respectively. None of the patients had fatal or severe complications and 15% (95% CI, 4%-35%) had moderate complications. During a mean (+/- standard deviation) follow-up of 29 (+/- 9.1) months, no neoplasia recurred. Limitations: Tertiary-care center, short follow-up. Conclusion: ER for visible abnormalities, followed by RFA of residual BE is a safe and effective treatment for BE >= 10 cm containing neoplasia, with a low chance of recurrence of neoplasia or BE during follow-up. (Gastrointest Endosc 2011;73:682-90.)