A procedure at Siteman Cancer Center that uses heat generated by radio waves to treat Barrett’s esophagus can eliminate signs of the potentially cancer-causing disorder and reduce the risk that the disease will progress. Findings reported in the New England Journal of Medicine from the first multicenter trial of a procedure called radiofrequency ablation, could mean patients have an alternative to surgery for treating Barrett’s esophagus. The procedure uses a scope inserted through the mouth to destroy the abnormal tissue.
“Patients with Barrett’s esophagus can go on to develop esophageal cancer,” says Steven A. Edmundowicz, MD, lead investigator at the School of Medicine study site. “Less than 15 percent of patients with esophageal adenocarcinoma survive for five years, and in those with advanced Barrett’s esophagus, the risk that the condition will advance to become cancer is about 6 percent per year.”
In Barrett’s esophagus, part of the lining of the esophagus is replaced with cells that resemble intestinal cells. Long-standing acid reflux disease is common in those who develop Barrett’s esophagus, which affects about 1 percent of adults in the United States.
A total of 127 patients at 19 sites took part in the study, which used endoscopes to diagnose the disease and deliver radiofrequency ablation. The technique heats and destroys the abnormal tissue while leaving the deeper layers undamaged.
All patients in the study had either low- or high-grade dysplasia associated with more advanced Barrett’s esophagus. They all received the antireflux medication esomeprazole (Nexium) to keep their reflux disease in check as much as possible.
In the patients who had the treatment, dysplasia disappeared in a little more than 90 percent of patients with low-grade disease and in more than 80 percent of high-grade patients, compared with about 23 percent of the low-grade patients and 19 percent of the high-grade patients who had a control procedure in which endoscopes were inserted and the esophagus examined but no radio waves were delivered. In 78 percent of treated patients, the dysplasia and the abnormal intestinal-type cells disappeared.
“From these short-term results, it appears we may have another useful tool in our treatment arsenal,” Edmundowicz says. “Additional follow-up will be necessary to demonstrate the true effectiveness of radiofrequency ablation in preventing esophageal cancer in patients with Barrett’s esophagus.” Shaheen NJ, et al. Radiofrequency ablation in Barrett’s esophagus with dysplasia. New England Journal of Medicine, vol. 330 (22), May 28, 2009.