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Current Controversies in Radiofrequency Ablation Therapy for Barrett’s Esophagus

Barrett’s esophagus (BE) is the most important risk factor for esophageal adenocarcinoma. Through the sequence of no dysplasia to low-grade dysplasia (LGD) and high-grade dysplasia (HGD), eventually early cancer (EC) may develop. The risk of neoplastic progression is relatively low, 0.5–0.9 % per pa...

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Autores principales: Belghazi, Kamar, Cipollone, Ilaria, Bergman, Jacques J. G. H. M., Pouw, Roos E.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Springer US 2016
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4783441/
https://www.ncbi.nlm.nih.gov/pubmed/26891725
http://dx.doi.org/10.1007/s11938-016-0080-4
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author Belghazi, Kamar
Cipollone, Ilaria
Bergman, Jacques J. G. H. M.
Pouw, Roos E.
author_facet Belghazi, Kamar
Cipollone, Ilaria
Bergman, Jacques J. G. H. M.
Pouw, Roos E.
author_sort Belghazi, Kamar
collection PubMed
description Barrett’s esophagus (BE) is the most important risk factor for esophageal adenocarcinoma. Through the sequence of no dysplasia to low-grade dysplasia (LGD) and high-grade dysplasia (HGD), eventually early cancer (EC) may develop. The risk of neoplastic progression is relatively low, 0.5–0.9 % per patient per year. However, once diagnosed, esophageal adenocarcinoma is often irresectable, and 5-year survival is only 15 %. Therefore, non-dysplastic BE patients are kept under endoscopic surveillance to detect early neoplasia in a curable stage. In case of LGD confirmed by an expert pathologist, risk of neoplastic progression is high. In these confirmed LGD patients, prophylactic ablation using radiofrequency ablation (RFA) of the Barrett’s segment has proven to significantly reduce risk of neoplastic progression. Once patients are diagnosed with HGD or EC, they have a clear indication for endoscopic treatment. The cornerstone for endoscopic management of early Barrett’s neoplasia is endoscopic resection of mucosal abnormalities. Endoscopic resection (ER) provides a large tissue specimen for accurate histological evaluation to select those patients for further endoscopic management, who have neoplasia limited to the mucosa, well to moderately differentiated and without lymph-vascular invasion. After ER, the remainder of the Barrett’s mucosa can be eradicated with RFA, to prevent occurrence of metachronous lesions.
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spelling pubmed-47834412016-03-22 Current Controversies in Radiofrequency Ablation Therapy for Barrett’s Esophagus Belghazi, Kamar Cipollone, Ilaria Bergman, Jacques J. G. H. M. Pouw, Roos E. Curr Treat Options Gastroenterol Esophagus (E Dellon, Section Editor) Barrett’s esophagus (BE) is the most important risk factor for esophageal adenocarcinoma. Through the sequence of no dysplasia to low-grade dysplasia (LGD) and high-grade dysplasia (HGD), eventually early cancer (EC) may develop. The risk of neoplastic progression is relatively low, 0.5–0.9 % per patient per year. However, once diagnosed, esophageal adenocarcinoma is often irresectable, and 5-year survival is only 15 %. Therefore, non-dysplastic BE patients are kept under endoscopic surveillance to detect early neoplasia in a curable stage. In case of LGD confirmed by an expert pathologist, risk of neoplastic progression is high. In these confirmed LGD patients, prophylactic ablation using radiofrequency ablation (RFA) of the Barrett’s segment has proven to significantly reduce risk of neoplastic progression. Once patients are diagnosed with HGD or EC, they have a clear indication for endoscopic treatment. The cornerstone for endoscopic management of early Barrett’s neoplasia is endoscopic resection of mucosal abnormalities. Endoscopic resection (ER) provides a large tissue specimen for accurate histological evaluation to select those patients for further endoscopic management, who have neoplasia limited to the mucosa, well to moderately differentiated and without lymph-vascular invasion. After ER, the remainder of the Barrett’s mucosa can be eradicated with RFA, to prevent occurrence of metachronous lesions. Springer US 2016-02-19 2016 /pmc/articles/PMC4783441/ /pubmed/26891725 http://dx.doi.org/10.1007/s11938-016-0080-4 Text en © The Author(s) 2016 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.
spellingShingle Esophagus (E Dellon, Section Editor)
Belghazi, Kamar
Cipollone, Ilaria
Bergman, Jacques J. G. H. M.
Pouw, Roos E.
Current Controversies in Radiofrequency Ablation Therapy for Barrett’s Esophagus
title Current Controversies in Radiofrequency Ablation Therapy for Barrett’s Esophagus
title_full Current Controversies in Radiofrequency Ablation Therapy for Barrett’s Esophagus
title_fullStr Current Controversies in Radiofrequency Ablation Therapy for Barrett’s Esophagus
title_full_unstemmed Current Controversies in Radiofrequency Ablation Therapy for Barrett’s Esophagus
title_short Current Controversies in Radiofrequency Ablation Therapy for Barrett’s Esophagus
title_sort current controversies in radiofrequency ablation therapy for barrett’s esophagus
topic Esophagus (E Dellon, Section Editor)
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4783441/
https://www.ncbi.nlm.nih.gov/pubmed/26891725
http://dx.doi.org/10.1007/s11938-016-0080-4
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