Because the progression of Barrett’s esophagus without dysplasia to esophageal cancer is very rare and the long-term benefit of treating these tissues to prevent esophageal cancer is not known; the ACG guidelines do not recommend the routine use of RFA in this situation. This is a very important point, and means that most patients who have Barrett’s esophagus will not require RFA, since most patients do not develop precancerous changes.
How effective is radiofrequency ablation therapy?
How is RFA performed?
Overall, RFA completely removes Barrett’s esophagus and dysplasia in a high proportion of patients, as shown in results from multiple clinical studies. The success rate is about 80 to 90 percent. However, once the RFA removes the Barrett’s, there is no guarantee that it might not develop again down the road. In fact, over 10 percent of patients who are treated successfully for Barrett’s esophagus with RFA develop have Barrett’s again months to years after the first treatment.
Fortunately, repeat treatments with ablation can eliminate these abnormal tissues entirely. Because of the possibility that the Barrett’s can form again, your doctor will likely recommend that you have regular endoscopies even after you have been successfully treated.
What should a patient expect before and after RFA?
The patient will undergo an upper GI endoscopy, with a careful examination of the esophagus, stomach, and the upper part of the small bowel using a camera fixed at the end of a special tube called an endoscope. The location of the Barrett’s or dysplastic tissues will then be identified, and the doctor will choose the appropriate ablation catheter for the treatment.
How many sessions are needed?
Before the procedure
The preparation is similar to preparing for an upper endoscopy. Do not eat or drink after midnight the day of or at least eight hours before the procedure. Make an arrangement to have someone drive you home after the procedure. Aspirin or other blood thinning medications will need to be stopped a few days before the procedures. Please check with your doctor for specific recommendations.
Day of the procedure
The procedure is usually performed in an outpatient setting under sedation. The time taken for the entire process may vary and usually takes less than one hour. Extra time is needed for preparation before the procedure and recovery from sedation after the procedure.
After the procedure
Because the esophagus is a sensitive organ, patients usually experience mild to intense chest pain, which improves gradually for several days following the procedure. Pain medications and numbing medicines will be prescribed by your doctor to help with your symptoms. You will need to take an acid suppressive medicine, usually a double dose of proton pump inhibitor, and an ulcer coating medicine (sucralfate) to assist the healing of the treated areas. A follow-up appointment will be scheduled by your doctor.
What is the recovery time from a RFA session?
On average, one to three RFA treatment sessions are required to completely remove all of the Barrett’s esophagus and or dysplastic tissue. A follow-up endoscopy is performed at two- to three-month intervals to reassess for further treatment.
What is the long-term follow-up?
Patients recover from the sedation within 30 to 60 minutes. Oral pain medications and numbing solution may be needed to reduce the chest discomfort. A modified, soft diet is usually recommended for the first few days after the procedure. Patients may return to work the day after their procedure.
What are the adverse effects of RFA?
Low acid is preferred to allow the esophagus to replace the destroyed tissue with normal tissue, also known as squamous mucosa. All patients will be treated with high-dose acid suppressive medicine using a proton pump inhibitor indefinitely. After the Barrett’s has been destroyed and replaced by normal tissue, patients will need periodic upper endoscopy to ensure that the Barrett's mucosa does not recur.
Are there any alternative treatments?
RFA is a safe and well-tolerated procedure. However, a large proportion of patients may have chest pain or pain when swallowing for 24 to 48 hours following the procedure. Most symptoms typically resolve within a few days.
About five percent of patients may develop narrowing of the esophagus, known as a stricture after RFA. A stricture may require additional procedures to stretch (dilate) the esophagus. Major bleeding or tear to the esophagus are uncommon and occur in less than 1 percent of patients.
Different therapies are available to destroy or remove Barrett’s esophagus or dysplasia, which you can discuss with your doctor. Some methods used currently include:
- Cryotherapy – a freezing method using liquid nitrogen;
- Photodynamic Therapy (PDT) – a method where a chemical is given intravenously, which makes the patient’s tissues reactive to a specific laser light. The light is then shined on the tissue to create a reaction that destroys the abnormal tissues;
- Argon Plasma Coagulation (APC) – a procedure using high power electric current, which is delivered by spraying argon gas onto the tissue; and
- Endoscopic Mucosal Resection (EMR) – an endoscopic procedure using special accessories to remove the abnormal tissues.
Author(s) and Publication Date(s)
Ronald Hsu, MD, FACG, FACP, FRCP, Clinical Professor of Medicine, University of California, Davis, School of Medicine – Published July 2019.
Shaheen NJ, Falk GW, PG Iyer et al: Diagnosis and Management of Barrett’s Esophagus. Am J Gastroenterol 2016; 111:30–50.
Shaheen NJ, Sharma P, Overholt BF et al: Radiofrequency ablation in Barrett’s esophagus with dysplasia with dysplasia. N Engl J Med 2009;360:2277-2288.
Orman ES, Li N, Shaheen NJ. Efficacy and durability of radiofrequency ablation for Barrett’s Esophagus: systemic review and meta-analysis. Clin Gastroenterol Hepatol 2013 Oct; 11(10):1245-55.
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