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Radiofrequency Ablation and Antireflux Management for Non-dysplastic Barrett’s Esophagus

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Innovation in Esophageal Surgery

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Abstract

Non-dysplastic Barrett’s esophagus (NDBE), this is columnar lined esophagus (CLE) with intestinal metaplasia (IM; goblet cells within CLE), results from gastroesophageal reflux disease (GERD) and harbors a 0.5 % annual risk for the development of esophageal adenocarcinoma (comparable to the risk of a colorectal polyp to proceed to colorectal cancer). Radiofrequency ablation (RFA) eliminates NDBE in 70 % and up to 97 % of the cases after one and two to four RFA treatments, respectively, and remains durable in 92 % of the cases after 5 years.

Medical GERD therapy alters the pH, but not the occurrence of the reflux. In contrast to that, effective antireflux surgery eliminates any reflux (acidic and non-acidic), and most importantly, impairs the reflux of compounds, which are suggested to aggravate GERD and promote the cancer development (i.e. bile acid, pancreatic enzymes). Usually RFA is followed by an high dose proton pump inhibitor (PPI) therapy. Recent evidence indicates that the combination of RFA and effective fundoplication increases the yield of the first RFA session to eliminate NDBE from 70 % to more than 90 %. Conceptually, the epidemiological characteristics and the genetic insecurities of NDBE, which are comparable to those of the advanced stages of the disease (dysplasia and cancer) justify RFA of NDBE for cancer prevention.

This chapter addresses the role of RFA and fundoplication for the “causal” management of GERD and NDBE. In addition, RFA and anti reflux surgery should consider our novel understanding of the anatomy and the histopathology of the esophagogastric junction (i.e. squamo-oxyntic gap; dilated distal esophagus). The majority of esophageal adenocarcinomas are missed by current surveillance strategies which focus on the symptomatic NDBE. Consequently we reason the impact of RFA for the elimination of asymptomatic NDBE.

Non dyplastic Barrett’s esophagus (NDBE) results from gastroesophageal reflux and harbors the same cancer risk like a colon polyp (0.5 % annual risk).

RFA is a new endoscopic therapy for effective and durable removal of NDBE.

The biological characteristics and diagnostic insecurities of NDBE justify the removal by RFA.

The article summarizes why RFA should be done at the stage of NDBE and why we should not wait until the development of dysplasia and cancer.

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Authors and Affiliations

  1. Manometry Lab, University Clinic of Surgery, Medical University Vienna, Vienna, Austria

    Stephanie Fischer See

  2. Department of General Surgery, University Clinic of Surgery, Medical University Vienna, Vienna, Austria

    Sebastian F. Schoppmann & Johannes Zacherl

  3. University Clinic of Surgery, Medical University Vienna, Vienna General Hospital, Vienna, Austria

    Martin Riegler

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  1. Stephanie Fischer See
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  2. Sebastian F. Schoppmann
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  3. Martin Riegler
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  4. Johannes Zacherl
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Corresponding author

Correspondence to Martin Riegler .

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Editors and Affiliations

  1. , Department ofSurgery, IRCCS Policlinico San Donato, San Donato Milanese (Mi), Italy

    Luigi Bonavina

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See, S.F., Schoppmann, S.F., Riegler, M., Zacherl, J. (2012). Radiofrequency Ablation and Antireflux Management for Non-dysplastic Barrett’s Esophagus. In: Bonavina, L. (eds) Innovation in Esophageal Surgery. Springer, Milano. https://doi.org/10.1007/978-88-470-2469-4_5

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  • DOI: https://doi.org/10.1007/978-88-470-2469-4_5

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