Radiofrequency ablation (RFA) may modestly reduce the prevalence of low-grade dysplasia (LGD) and the risk of progression at 3 years in patients with Barrett esophagus, according to a study recently published in Gut.1

The annual neoplastic progression rate of Barrett esophagus with LGD is between 9% and 13% per year. Therefore, radiofrequency ablation (RFA) has been proposed as an alternative to surveillance.1 However, because only two studies have assessed endoscopic RFA for the treatment of Barrett esophagus with LGD,2,3 researchers aimed at confirming these results by conducting a randomized controlled trial with a similar design at 14 centers (Clinicaltrials.gov identifier: NCT01360541). Investigators compared RFA (maximum of 4 sessions) with annual endoscopic surveillance and included patients with a confirmed diagnosis of Barrett esophagus with LGD.1 In this study, 125 patients were initially included, of which 82 with confirmed LGD were randomized to the RFA group (n=40) and to the surveillance group (n=42).

The researchers found that at 3 years, complete eradication of intestinal metaplasia rates were 35% compared with 0% in the RFA and surveillance groups, respectively (P <.001). At the same time, the prevalence of LGD was 34.3% in the RFA group compared with 58.1% in the surveillance group (P =.05). Neoplastic progression was found in 12.5% (RFA) compared with 26.2% (surveillance; P =.15). The complication rate was maximal after the first RFA treatment (16.9%).


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“In conclusion, in this multicentre randomised study in patients with Barrett esophagus and a confirmed diagnosis of LGD, RFA alone did not significantly reduce the prevalence of LGD or the rate of neoplastic progression at 3 years,” stated the authors.1 They added, “The risk-benefit balance of endoscopic ablation therapy should therefore be carefully weighted before offering this treatment to patients with LGD.”1

Disclosure: Several study authors declared affiliations with the pharmaceutical industry. Please see the original reference for a full list of authors’ disclosures.

References

  1. Barret M, Pioche M, Terris B, et al. Endoscopic radiofrequency ablation or surveillance in patients with barrett’s oesophagus with confirmed low-grade dysplasia: a multicentre randomised trial. Gut. Published online March 8, 2021.  doi: 10.1136/gutjnl-2020-322082
  2. Shaheen NJ, Sharma P, Overholt BF, et al. Radiofrequency ablation in barrett’s esophagus with dysplasia. N Engl J Med. 2009;360(22):2277–88.
  3. Phoa KN, van Vilsteren FGI, Weusten BLAM, et al. Radiofrequency ablation vs endoscopic surveillance for patients with barrett esophagus and low-grade dysplasia: a randomized clinical trial. JAMA. 2014;311(12):1209–17.