Journal Club

Next journal club - 13th December 2010
Presenter : Dr. Krishna

Radiofrequency Ablation in Barrett's Esophagus with Dysplasia
The New England Journal of Medicine
May 28, 2009
Vol 360 No 22

Background
Barrett’s esophagus, a condition of intestinal metaplasia of the esophagus, is associated
with an increased risk of esophageal adenocarcinoma. We assessed whether
endoscopic radiofrequency ablation could eradicate dysplastic Barrett’s esophagus
and decrease the rate of neoplastic progression.
Methods
In a multicenter, sham-controlled trial, we randomly assigned 127 patients with dysplastic
Barrett’s esophagus in a 2:1 ratio to receive either radiofrequency ablation
(ablation group) or a sham procedure (control group). Randomization was stratified
according to the grade of dysplasia and the length of Barrett’s esophagus. Primary
outcomes at 12 months included the complete eradication of dysplasia and intestinal
metaplasia.
Results
In the intention-to-treat analyses, among patients with low-grade dysplasia, complete
eradication of dysplasia occurred in 90.5% of those in the ablation group, as compared
with 22.7% of those in the control group (P<0.001). Among patients with highgrade
dysplasia, complete eradication occurred in 81.0% of those in the ablation group,
as compared with 19.0% of those in the control group (P<0.001). Overall, 77.4% of
patients in the ablation group had complete eradication of intestinal metaplasia, as
compared with 2.3% of those in the control group (P<0.001). Patients in the ablation
group had less disease progression (3.6% vs. 16.3%, P = 0.03) and fewer cancers
(1.2% vs. 9.3%, P = 0.045). Patients reported having more chest pain after the ablation
procedure than after the sham procedure. In the ablation group, one patient had
upper gastrointestinal hemorrhage, and five patients (6.0%) had esophageal stricture.
Conclusions
In patients with dysplastic Barrett’s esophagus, radiofrequency ablation was associated
with a high rate of complete eradication of both dysplasia and intestinal metaplasia and
a reduced risk of disease progression. (ClinicalTrials.gov number, NCT00282672.)