ASGE Esophagology: Tailoring Management from Testing to Treatment (Live and Virtual) | July 2022-Trindade

Trindade_Ablation Therapy for Barrett's Esophagus

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Ablation techniques are effective for treating Barrett's esophagus and reducing the risk of developing esophageal adenocarcinoma (EAC). Studies have shown that ablation can significantly lower the progression risk of EAC in patients with non-dysplastic Barrett's esophagus (NDBE), low-grade dysplasia (LGD), and high-grade dysplasia (HGD). The number needed to treat (NNT) to avoid one cancer over five years is 45 for NDBE, 13 for LGD, and 4 for HGD.<br /><br />Guidelines recommend not ablating NDBE but instead focusing on resecting any raised lesions. For LGD, there is a choice between surveillance or treatment, whereas HGD and EAC should be resected and the remaining Barrett's esophagus ablated. Ablation should be done every 2-3 months until complete eradication is achieved, followed by post-eradication surveillance.<br /><br />Various ablative techniques are available, with radiofrequency ablation (RFA) being a precise method that uses tightly spaced electrodes, preset energy and power densities, and a generator that turns off when a specific resistance level in the ablated tissues is reached.<br /><br />In addition to RFA, cryotherapy is another option for cases of RFA refractory disease or when nodular disease is not amenable to resection or surgery. Liquid nitrogen cryotherapy, using a non-contact spray at -196 degrees Celsius, can be effective, especially for large hiatal hernias or in retroflex.<br /><br />There are also newer ablation systems like the C2 CryoBalloon™ Ablation System, which uses nitrous oxide and a balloon catheter to deliver cryogen to the targeted area, and hybrid argon plasma coagulation (hAPC), which involves submucosal injection of saline and ablation at higher energy levels than traditional APC.<br /><br />Overall, the conclusion is that endoscopic eradication therapy for dysplastic disease is effective, and the approach should involve resecting nodular disease and ablating flat disease. There are multiple tools available in the ablation toolbox to choose from.

Keywords

ablation techniques

Barrett's esophagus

esophageal adenocarcinoma

NDBE

LGD

HGD

radiofrequency ablation

cryotherapy

C2 CryoBalloon™ Ablation System

hybrid argon plasma coagulation