ASGE Esophagology: Tailoring Management from Testing to Treatment (On-Demand) | July 2022-Ablation Therapy for Barrett's Esophagus

Ablation Therapy for Barrett's Esophagus

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This document provides an overview of ablation techniques for Barrett's esophagus, a condition that can lead to esophageal adenocarcinoma (EAC). The author discusses the impact of ablation on the natural history of EAC, noting that studies have shown a decreased risk of progression to EAC after ablation. The number needed to treat (NNT) to avoid one cancer over five years is also calculated for different stages of Barrett's esophagus.<br /><br />The document discusses when to perform endoscopic ablation, emphasizing that non-dysplastic Barrett's esophagus (NDBE) should not be ablated, and that all raised lesions should be resected. For low-grade dysplasia (LGD), the approach can be either surveillance or treatment, while high-grade dysplasia (HGD) and EAC should be treated with resection and ablation. The author recommends ablating every 2-3 months until the Barrett's esophagus is eradicated, followed by post-eradication surveillance.<br /><br />Various ablation techniques are described, including radiofrequency ablation (RFA) and cryotherapy. RFA is discussed in detail, highlighting its precise ablation depth and the mechanisms involved. The author also mentions the AIM Dysplasia Trial, a randomized controlled trial that showed significant differences in disease eradication and progression between RFA and surveillance arms.<br /><br />Cryotherapy is mentioned as a treatment option for RFA refractory disease or nodular disease that cannot be resected. Liquid nitrogen cryotherapy is described, including the use of a spray cryotherapy technique and a catheter for delivery.<br /><br />Other ablation techniques mentioned include the C2 CryoBalloon Ablation System, which uses nitrous oxide to spray cryogen onto the mucosa, and hybrid argon plasma coagulation (hAPC), which involves submucosal injection of saline and ablating at higher energy levels.<br /><br />The document concludes by emphasizing that endoscopic eradication therapy is effective for dysplastic disease, recommending resection for nodular disease and ablation for flat disease. It also highlights the availability of multiple tools for ablation in the treatment of Barrett's esophagus.

Keywords

ablation techniques

Barrett's esophagus

esophageal adenocarcinoma

natural history

endoscopic ablation

radiofrequency ablation

cryotherapy

AIM Dysplasia Trial

liquid nitrogen cryotherapy

dysplastic disease