Background and study aim: Endoscopic resection with radiofrequency ablation (RFA) 6 weeks later safely and
effectively eradicates Barrett’s esophagus with high grade dysplasia (HGD) and early
cancer. After widespread endoscopic resection, related scarring may hamper balloon-based
circumferential RFA (c-RFA). However c-RFA immediately followed by endoscopic resection
in the same session might avoid the impact of scarring and reduce laceration and stenosis
risk. We aimed to assess the feasibility of such an approach.
Patients and methods: Patients with Barrett’s esophagus ≥ 3 cm and ≥ 1 visible lesion (HGD/early cancer)
were included. Visible lesions were marked with cautery, and c-RFA (12 J/cm2) was delivered using two applications and a cleaning step, followed by resection
of the delineated area. Outcome measures were surface regression of Barrett’s esophagus
at 3 months, need for subsequent c-RFA, complications, and quality of resection specimens.
Results: 24 patients (20 men, 4 women; mean age 68 years, standard deviation [SD] 12; Barrett’s
esophagus median length C6M8) underwent single-session c-RFA + endoscopic resection,
providing a median of 4 (interquartile range [IQR] 2 – 6) resection specimens (early
cancer 18 patients; HGD 6). Complications included 1 perforation, 4 bleedings, and
5 stenoses; all were managed endoscopically. Specimens allowed assessment of neoplasia
depth, differentiation, and lymphatic/vascular invasion. Median Barrett’s esophagus
surface regression at 3 months was 95 %. No patient required a second c-RFA procedure
and 40 % required repeat endoscopic resection for visible lesions. Complete response
for neoplasia was achieved in 100 % and complete response for intestinal metaplasia
(CR-IM) in 95 %.
Conclusions: c-RFA followed by endoscopic resection in the same session is feasible, but technically
demanding and associated with a substantial rate of complications and repeat endoscopic
resection. This approach should be reserved for selected cases in expert centers,
with endoscopic resection and RFA 6 – 8 weeks later remaining the standard combined
approach.
