Radiofrequency Ablation Treatment for Barrett's Esophagus
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About This Procedure
Radiofrequency Ablation (RFA) is an FDA-approved endoscopic technique in which diseased tissue is exposed to heat energy and destroyed. Specialists at the Massachusetts General Hospital Barrett’s Esophagus Treatment Center offer RFA to treat Barrett's esophagus.
RFA was first used to treat Barrett’s esophagus in 2005. Since then, more than 50 clinical studies have demonstrated the safety and efficacy of RFA for complete removal of Barrett's esophagus, as well as reducing progression of dysplasia to esophageal cancer. These studies have demonstrated successful removal of dysplasia in more than 90% of patients undergoing therapy.
Gastroenterologists at the Mass General Barrett's Esophagus Treatment Center have been performing RFA since 2008 and have performed hundreds of successful RFA procedures.
How Does Radiofrequency Ablation Work?
RFA for Barrett's esophagus is performed on an outpatient basis by a gastroenterologist. Under the care of an anesthesiologist, the patient will receive either deep sedation or general anesthesia.
An electrode mounted on a balloon catheter or a thin, flexible tube (endoscope) is used to deliver heat energy directly to the diseased lining of the esophagus. The gastroenterologist will choose one of three electrodes for the procedure. The predominant factor in which electrode is used will be the length/amount of Barrett's esophagus to treat. The energy delivered by the electrode results in high temperature heating of the Barrett’s lining. This process typically takes 25 to 35 minutes and leads to ablation of the tissue.
This tissue sloughs off over 48 to 72 hours following the procedure. Over a period of six to eight weeks, this tissue is replaced by normal (squamous) lining.
What Preparation Is Required Before Radiofrequency Ablation?
Patients with high-grade dysplasia often undergo an endoscopic ultrasound exam to ensure there is no deeper tissue involvement before undergoing RFA.
The patient will be asked not to eat or drink anything after midnight the night before the procedure. If the patient takes daily medication in the form of a pill, he/she may take it with sips of water the morning of the RFA.
What Is the Recovery Time and Follow-Up?
Patients are discharged from the Mass General endoscopy unit with prescriptions for oral pain medications and an oral numbing solution they may use for five to seven days.
A modified diet is recommended for the first three days after the procedure to allow time for healing. Patients may return to work the day after the procedure.
All patients with Barrett’s esophagus will also be treated with high-dose antacids (typically in the proton pump inhibitor family) indefinitely. A low-acid environment helps the body replace the removed tissue with normal tissue (squamous mucosa). Patients will remain in a surveillance program indefinitely to ensure that the Barrett's mucosa, or diseased tissue, does not recur.
For most patients, one to three RFA treatment sessions are required to remove all of the Barrett’s mucosa.
Patients who are treated with RFA return for a follow-up endoscopy in two to three months to ensure they are healing properly and to determine if additional treatment is required. Surveillance endoscopy is performed on a regular basis after all of the Barrett’s esophagus has been adequately treated, starting every six months, with increasing intervals with each normal follow-up examination.
How Safe Is the Procedure?
RFA is a safe and well-tolerated procedure. However, about 20% of patients may have chest pain following the procedure.
About 5% of patients may develop narrowing of the esophagus (known as a stricture) as a result of RFA and may require one or more procedures to stretch the esophagus (known as dilations) to treat this. Strictures are more common in patients who have had previously undergone endoscopic mucosal resection (EMR).
Major complications are very uncommon (occur in less than 1% of patients), but may include bleeding or perforation of the esophagus.
RFA is performed at Mass General in Boston and at the Mass General/North Shore Center for Outpatient Care in Danvers, MA.
What Other Ablation Procedures Are Available?
The Mass General Barrett's Esophagus Treatment Center also performs cryotherapy, an FDA-approved ablation procedure that uses cold temperatures to destroy diseased tissue.
Presently, there are no studies comparing the efficacy of RFA with cryotherapy to treat dysplasia due to Barrett's esophagus. A number of factors go into deciding which form of ablation is recommended for an individual patient. These include anatomic factors, co-existing medical conditions and patient preference. Some patients who are treated with one form of therapy may be transitioned to the other form of ablation based upon tolerance, side effects and effectiveness of the treatment.