ASGE Postgraduate Course at ACG 2022: Expanding the Scope of Fundamental and Advanced Endoscopy | October 2022-1 Shaheen All Barretts Should be Ablated

1 Shaheen All Barretts Should be Ablated

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The author, Nicholas Shaheen, presents an argument for ablating all cases of Barrett's esophagus (BE), which is a condition that increases the risk of developing esophageal cancer. Shaheen argues against those who claim that there is not enough data to support ablating non-dysplastic BE (NDBE) and proposes that endoscopic surveillance, which is often recommended in such cases, lacks supporting data.<br /><br />Shaheen cites data from the U.S. RFA Registry showing a significant decrease in the rate of cancer development in NDBE patients after radiofrequency ablation (RFA) compared to historical controls. He acknowledges that the risk of cancer in BE is lower compared to other cancers but questions why there is a significant effort to prevent colon cancer despite its lower lethality, while the risk of cancer in BE is dismissed.<br /><br />Regarding safety, Shaheen presents data showing low complication rates and no deaths associated with ablating BE patients. He argues that those who oppose ablation due to lack of data ironically advocate for endoscopic surveillance, which has little supporting data and low chances of successful administration.<br /><br />Shaheen acknowledges that most analyses suggest that ablation may not be as cost-effective as surveillance but questions the effectiveness of surveillance itself. He cites an analysis suggesting that ablating all NDBE cases and avoiding surveillance may be the most cost-effective strategy.<br /><br />The author also highlights the issue of lost follow-up and the incorrect or lack of appropriate follow-up in patients with BE. He suggests that improving ablation techniques, making it safer and more effective, and addressing the evidence required to support its utility in the NDBE population should be the focus.<br /><br />In conclusion, Shaheen argues for ablating all BE cases, stating that it is effective, safe, affordable, and necessary for a group with a higher cancer risk. He dismisses concerns about lack of data and challenges the effectiveness of surveillance as an alternative.

Keywords

Nicholas Shaheen

Barrett's esophagus

esophageal cancer

ablating

non-dysplastic BE

endoscopic surveillance

U.S. RFA Registry

radiofrequency ablation

complication rates

cost-effective strategy