Radiofrequency Ablation

Radiofrequency ablation (RFA) is a procedure using high-energy radio waves to burn and destroy pre-cancerous cells. This method has been used to treat various conditions in different parts of the body, including precancerous conditions of the esophagus. Special devices are made to deliver the energy in different settings.

Barrett’s esophagus is a condition in which the normal lining of the wall of the esophagus (the food pipe connecting the mouth to the stomach) is being replaced by cells similar to that of the stomach due to acid reflux from the stomach. This is found in about 10 to 15 percent of patients with gastroesophageal reflux disease (GERD).

Barrett’s esophagus does not generally “heal” itself or change back to normal tissue, even when it is being treated with the acid reflux medicines that stops heartburn. Medications such as omeprazole, esomeprazole, lansoprazole, pantoprazole, dexlansoprazole, and rabeprazole, which are commonly used for acid reflux, will not make Barrett’s esophagus go away. Barrett’s esophagus can progress into a precancerous state in a small percentage of patients. If these precancerous cells are not eliminated, they can further progress into esophageal cancer. Treatment of dysplasia with RFA in patients with Barrett’s esophagus has been shown to prevent esophageal cancer.

RFA uses heat energy to destroy the precancerous cells. The burned tissue sloughs off over 48 to 72 hours following the procedure. The patient is then treated with a high dose of proton pump inhibitor, a potent acid suppressive medicine, and an ulcer coating agent called sucralfate. Over a period of six to eight weeks, the area will be replaced by new, normal lining.

Guidelines from the American College of Gastroenterology published in 2015 recommend that all patients with high grade dysplasia be treated with RFA therapy. Patients with nodules, or bumps, in their Barrett’s may require removal of these bumps prior to treatment with RFA. This removal of nodules is known as endoscopic mucosal resection, or “EMR.” For patients with confirmed low-grade dysplasia and without a short life expectancy, endoscopic therapy such as RFA is considered as the preferred treatment. In the case of low-grade dysplasia, another alternative to RFA is to continue to monitor the condition with endoscopies every 12 months, and only to perform the RFA treatments if the Barrett’s shows progression to high-grade dysplasia or early cancer. This is because low-grade dysplasia turns to cancer less frequently than high-grade dysplasia.

Because the progression of Barrett’s esophagus without dysplasia to esophageal cancer is very rare and the long-term benefit of treating these tissues to prevent esophageal cancer is not known; the ACG guidelines do not recommend the routine use of RFA in this situation. This is a very important point, and means that most patients who have Barrett’s esophagus will not require RFA, since most patients do not develop precancerous changes.