DDW 2009 includes 20 scientific presentations related to the use of RFA for Barrett’s esophagus, the most prominent of which are:

Two Year Follow-up of the AIM Dysplasia Trial:  Endoscopic biopsies were assessed from the randomized, sham-controlled multi-center trial at 2 years after radiofrequency ablation (RFA) in patients with complete response at 1-year follow-up. Of these patients, 93.3% continued to be free of IM, indicating reversion to a histologically normal neosquamous epithelium after RFA treatment for dysplastic BE is durable at 2-year follow-up. 

ASGE Plenary Session:  Three European centers compared stepwise radical endoscopic resection (SRER) vs. RFA when treating advanced Barrett’s neoplasia with or without early cancer. Complete eradication of dysplasia and IM was achieved in 95-100% of patients in both groups. However, a combined approach of focal endoscopic resection (ER) for visible lesions followed by RFA is recommended due to the higher risks of complications and more procedures associated with SRER.

Community Practice Setting:  Safety and efficacy of RFA was evaluated for 429 patients from four expert community hospitals. The favorable safety profile and histology-based efficacy outcomes were comparable to those from published studies: Complete response of 100% for dysplasia and 78% for IM in patients with > 1 year post-RFA endoscopic biopsy follow-up.)

European Multi-center Trial (EURO-II Trial):  After combined modality ER plus RFA for advanced Barrett’s neoplasia and early cancer in 62 patients, investigators reported that 95% of patients showed no evidence of dysplasia or IM at 17 months follow-up.

Squamous High Grade Dysplasia – UK RFA Experience:  Squamous dysplasia is the precancerous lesion of squamous cell carcinoma (SCC) of the esophagus. -. Promising initial results demonstrate circumferential RFA can be safe and effective treatment for squamous HGD in patients. Additional trials assessing RFA for SCC are underway in China.

Importance of Verifying Complete Eradication of BE to Avoid False Positive Diagnosis of Buried Barrett’s:   Buried Barrett’s (BB) is concerning in that it may undergo disease progression that is not endoscopically evident until late stage. The authors found that only 0.08% of post-RFA neosquamous epithelium biopsies were interpreted as having BB, compared to 21% of biopsies from small (<5mm) residual BE islands post-RFA. Thus, it is important to completely rule out small islands of residual BE in post-RFA NSE to avoid a false positive diagnosis of BB.

Is Buried Barrett’s Undetectable due to Scarring or Truly Rare? Pouw RE, Gondrie JJ, Rygiel AM, et al. Am J Gastroenterol advance online publication, 21 April 2009: There is concern that post-ablation scarring of the neosquamous epithelium (NSE) may limit the ability of biopsies to detect buried Barrett’s (BB). The authors employed traditional biopsies, deeper keyhole biopsies and yet deeper endoscopic resection in both post-RFA NSE and untreated squamous epithelium (USE). There was no difference in tissue sampling depth between NSE and USE, and no BB was found. Therefore, scarring does not limit biopsy adequacy and BB truly is rare after complete ablation.