Monday, April 14, 2014

Research Highlights: Radiofrequency Ablation Associated with a Decreased Rate of Cancer Development from Barrett Esophagus with Low-Grade Dysplasia

Radiofrequency Ablation Associated with a Decreased Rate of Cancer Development from Barrett Esophagus with Low-Grade Dysplasia

In western nations, esophageal cancer is becoming an increasingly prevalent threat.  Barrett esophagus - a disorder affecting the esophageal lining – is associated with an increased risk of esophageal cancer when it is accompanied by low-grade esophageal dysplasia. It is thus important to stop this disorder from progressing into a cancerous state. A study recently published in the Journal of the American Medical Association (JAMA) has investigated whether radiofrequency ablation could be an effective treatment for individuals suffering from Barrett esophagus with low-grade dysplasia, and prevent the development of more serious dysplasia or of esophageal cancer.
Patients at nine different European Barrett treatment centers participated in this study. Experimenters only deemed patients eligible if they had received an endoscopy revealing a clear case of Barrett esophagus with low-grade dysplasia, had a life expectancy of greater than two years, and were between the ages of 18 and 85. After screening for eligibility, experimenters randomly assigned participants to either an experimental or control group, with the experimental group receiving a radiofrequency ablation treatment and the control group receiving endoscopic surveillance. This experiment was double blind, so experimenters and patients alike were unaware of each patient’s group assignment.
Patients in the experimental group received treatment every three months from either a circumferential or focal ablation device, depending on the nature and severity of their disorder. This treatment continued until the patient’s incidence Barrett esophagus had been eliminated, or until a certain maximum number of ablation session had been reached. Experimenters then performed a follow-up endoscopy three months later to observe any changes in the patient’s health. Experimenters continued to perform regular follow-up endoscopies until three years after the initial ablation. Patients in the control group received high-resolution endoscopies regularly for three years after the initial group randomization but did not undergo any ablation. During endoscopies, experimenters checked primarily for incidence of high-grade dysplasia or cancer.
Results showed that patients treated with radiofrequency ablation experienced an overall 7.4% decrease in risk of progression to esophageal cancer compared to patients receiving no ablation treatment. Patients in the experimental group also displayed greater incidence of complete erasure of dysplasia. Overall, experimenters observed that radiofrequency ablation was associated with a significantly reduced risk of high-grade dysplasia and cancer development in patients afflicted with Barrett esophagus with low-grade dysplasia. Experimenters recommended ablation therapy as an effective treatment for this disorder.

Caroline Russell-Troutman is the 2013-2014 Research Highlights Editor
JAMA. 2014;311(12):1209-1217. doi:10.1001
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