WebMD Medical News
Louise Chang, MD
May 27, 2009 -- Radiofrequency ablation may zap away the potentially precancerous cells associated with Barrett’s esophagus.
A new study shows radiofrequency ablation, which uses heat generated by radio waves to selectively destroy tissue, completely eradicated the abnormal cell growths lining the esophagus in more than 77% of those who received the treatment.
Barrett’s esophagus is usually the result of GERD (gastroesophageal reflux disease), in which repeated acid reflux causes the cells that line the esophagus to be replaced by the type of cells normally found in the intestine. Most people with GERD will not develop Barrett's esophagus. According to background information noted in the study, about 10% of people with chronic GERD will develop Barrett's esophagus.
The condition itself is not life-threatening, but a small proportion of people with Barrett’s esophagus go on to develop esophageal adenocarcinoma, one of the most deadly forms of cancer.
Until now, the only other option to reduce the risk of cancer growth from abnormal cells was surgery. Radiofrequency ablation is a much less invasive option.
In the study, researchers compared the effectiveness of the radiofrequency ablation treatment to destroy abnormal cells in the esophagus vs. a sham treatment in 127 people with Barrett’s esophagus. Both procedures involved endoscopy, or the passage of a catheter through the mouth into the esophagus.
During the radiofrequency ablation treatment, a balloon with a set of electromagnetic coils is placed at the site of the abnormal cell growth in the esophagus.
“Energy is then passed through the electromagnetic coils and, because we know how far apart the coils are spaced and how much energy is being put through them, we get a very reliable depth of burn, such that you can kill the abnormal cells on the inner surface without damaging the whole organ," researcher Nicholas Shaheen, MD, associate professor at the University of North Carolina at Chapel Hill Schools of Medicine, says in a news release.
Overall, the results show that 77.4% of those treated with radiofrequency ablation had a complete eradication of the abnormal cell growth compared with 2.3% in the sham group 12 months after treatment.
In addition, significantly fewer of those with Barrett’s esophagus treated with radiofrequency ablation had esophageal cancer within the study’s 12-month follow-up period, 1.2% vs. 9.3%.
There were no deaths related to the procedure. The authors note three adverse events among the radiofrequency ablation participants: a patient with gastrointestinal hemorrhage who was also taking anti-clotting medication for heart disease, another with new chest pain that developed eight days after the procedure, and a patient who reported chest discomfort and nausea soon after the procedure.
Other types of ablation have been studied in treating Barrett’s esophagus, but experts say these results, published in the New England Journal of Medicine, are the most promising so far.
Even so, more study is needed to determine the best candidate for the procedure before radiofrequency ablation is promoted as a widespread treatment for Barrett’s esophagus, says Jacques J.G.H.M Bergman, MD, PhD, of the Academic Medical Center in Amsterdam, Netherlands, in an editorial that accompanies the study.
SOURCES:Shaheen, N. The New England Journal of Medicine, May 28, 2009; vol 360: pp 2277-2288.News release, University of North Carolina at Chapel Hill.
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