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

1 Shaheen All Barretts Should be Ablated

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In this document, Dr. Nicholas Shaheen discusses the topic of ablating Barrett's esophagus (BE) as a preventive measure for cancer. He provides several key points in favor of ablating all cases of BE. He begins by stating that the benefits of endoscopic eradication therapy (EET) must outweigh the risks. The potential risks include peri-procedural complications, incomplete ablation, and cost, while the potential benefits include decreased cancer risk, psychological benefit, and cost-effectiveness.<br /><br />Dr. Shaheen acknowledges the arguments against ablating all cases of BE, including lack of data, low risks of progression, potential harm, and high cost. However, he argues that the available data supports the efficacy of ablation in preventing the development of cancer in patients with non-dysplastic BE (NDBE).<br /><br />He presents data from the U.S. RFA Registry, which shows a significantly decreased rate of cancer in NDBE patients after ablation compared to historical controls. Though not a head-to-head comparison, the data suggests a 50-90% decrease in cancer risk with ablation.<br /><br />Dr. Shaheen also addresses the argument that the risk of cancer is too low in BE to justify endotherapy. He contrasts the efforts made to prevent colon cancer, which has a lower risk, with the lack of effort in preventing esophageal adenocarcinoma (EAC) in BE patients.<br /><br />Regarding safety, Dr. Shaheen highlights that the complications associated with EET are relatively low, with a low rate of complications like strictures, bleeding, and perforation.<br /><br />He critiques the alternative of endoscopic surveillance, stating that there is little supporting data for its efficacy, and many flaws in its implementation. He emphasizes that ablating all cases of BE is a more effective and reliable approach.<br /><br />Cost-effectiveness is another consideration. While some analyses suggest that ablation may not be as cost-effective as surveillance, Dr. Shaheen argues that these analyses take into account poorly understood variables and that ablation could be more cost-effective in the long run.<br /><br />He concludes by posing several important questions, such as how to make ablation more affordable, safer, and effective. He also highlights the need for further evidence to support the utility of EET in the NDBE population.<br /><br />Overall, Dr. Shaheen advocates for ablating all cases of BE, citing its effectiveness, safety, affordability, and timeliness, as well as the higher cancer risk in this population compared to other endoscopic interventions.

Keywords

ablating Barrett's esophagus

endoscopic eradication therapy

cancer prevention

non-dysplastic Barrett's esophagus

cancer risk reduction

cost-effectiveness

complications of endoscopic therapy

esophageal adenocarcinoma

endoscopic surveillance

cost analysis