Major Finding: After radiofrequency ablation had achieved complete eradication of intestinal metaplasia, eradication was maintained in 92% of Barrett's esophagus patients at 5 years.
Data Source: A 5-year follow-up study that included 50 patients.
Disclosures: Dr. Fleischer has received research support and “other financial benefit” from BARRX Medical and research support from AstraZeneca, the study sponsors.
NEW ORLEANS — In a prospective, multicenter trial of Barrett's esophagus patients, radiofrequency ablation achieved complete eradication of intestinal metaplasia, which was maintained for at least 5 years in 92% of 50 patients.
The findings may have implications for future Barrett's surveillance recommendations, said Dr. David E. Fleischer.
Since annual rates of progression to esophageal carcinoma are low—less than 1% according to most studies—watchful waiting is the usual approach for patients with intestinal metaplasia. Although national guidelines recommend surveillance only, ablation offers an alternative for some patients.
“When I explain [that] this could be an alternative to surveillance to my patients, they almost always prefer to have the procedure done,” said Dr. Fleischer of the Mayo Clinic, Scottsdale, Ariz.
He presented 5-year follow-up data on patients enrolled in the Ablation of Intestinal Metaplasia (AIM-II) Trial. The 70 patients originally enrolled in this study had 2 cm to 6 cm of Barrett's esophagus and histologic evidence of intestinal metaplasia without dysplasia. All received circumferential radiofrequency ablation of the affected area. The treatment was repeated in 4 months if a follow-up endoscopy showed residual disease.
A prior study reported 2.5-year outcomes in this group (Gastrointest. Endosc. 2008;68:867-76). For the 5-year follow-up, 50 patients who had complete eradication of intestinal metaplasia at 2.5 years (37 men, mean age 59 years) underwent a repeat endoscopy at 5 years, with a mean of 31 biopsy specimens obtained.
None of the patients had esophageal stricture or mucosal lesions. In 46 patients (92%), there was complete eradication of intestinal metaplasia. The other four patients (8%) had low levels of residual disease and underwent a single session of radiofrequency ablation. A repeat endoscopy and biopsy 2 months later showed no evidence of disease in all four patients.
“Radiofrequency ablation represents a durable, long-term approach to treating Barrett's esophagus and restoring cells to normal,” Dr. Fleischer said. “We've shown that by treating patients with early Barrett's, we were able to eliminate the disease in most instances, and we hope that will lead to a reduction in the cancer associated with [Barrett's esophagus].”
He pointed out that only additional long-term follow-up with many more patients would be able to determine if radiofrequency ablation offers a complete cure for Barrett's.
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