Balloon-based, circumferential, endoscopic radiofrequency ablation of Barrett’s esophagus: 1-year follow-up of 100 patients (with video) - 22/08/11

Doi : 10.1016/j.gie.2006.09.033

Virender K. Sharma, MD ^⁎, Kenneth K. Wang, MD, Bergein F. Overholt, MD, Charles J. Lightdale, MD, M. Brian Fennerty, MD, Patrick J. Dean, MD, Douglas K. Pleskow, MD, Ram Chuttani, MD, Alvaro Reymunde, MD, Nilda Santiago, MD, Kenneth J. Chang, MD, Michael B. Kimmey, MD, David E. Fleischer, MD
Current affiliations: Division of Gastroenterology and Hepatology, Mayo Clinic Scottsdale/Phoenix, Scottsdale, Arizona (V.K.S., D.E.F.), Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota (K.K.W.), Gastrointestinal Associates, Knoxville, Tennessee (B.F.O.), Division of Digestive and Liver Diseases, Columbia Presbyterian Medical Center, New York, New York (C.J.L.), Division of Gastroenterology, Oregon Health Sciences University, Portland, Oregon (M.B.F.), GI Pathology Partners, Memphis, Tennessee (P.J.D.), Division of Gastroenterology, Beth Israel Deaconess Medical Center, Boston, Massachusetts (D.K.P., R.C.), Ponce Gastroenterology, Ponce, Puerto Rico (A.R., N.S.), Division of Gastroenterology, University of California at Irvine, Irvine, California (K.J.C.), Division of Gastroenterology, University of Washington Medical Center, Seattle, Washington (M.B.K.), USA

Reprint requests: Virender K. Sharma, MD, Mayo Clinic, Scottsdale/Phoenix, 13400 East Shea Blvd, Scottsdale, AZ 85259.

Scottsdale, Arizona, Rochester, Minnesota, Knoxville and Memphis, Tennessee, New York, New York, Portland, Oregon, Boston, Massachusetts, Irvine, California, Seattle, Washington, USA

Abstract

Objective

To assess the dose-response, safety, and efficacy of circumferential endoscopic ablation of Barrett’s esophagus (BE) by using an endoscopic balloon–based ablation device (HALO³⁶⁰ System).

Design

This study was conducted in 2 serial phases (dosimetry phase and effectiveness phase) to evaluate a balloon-based ablation device that delivers a pre-set amount of energy density (J/cm²) to BE tissue. The dosimetry phase evaluated the dose-response and the safety of delivering 6 to 12 J/cm². The effectiveness phase used 10 J/cm² (delivered twice [×2]) for all patients, followed by EGD with biopsies at 1, 3, 6, and 12 months. A second ablation procedure was performed if BE was present at 1 or 3 months. Patients received esomeprazole 40 mg twice a day for 1 month after ablation, and 40 mg every day thereafter. Postablation symptoms were quantified by using a 14-day symptom diary (scale, 0-100). A complete response (CR) was defined as all biopsy specimens negative for BE at 12 months.

Setting

Eight U.S. centers, between September 2003 and September 2005.

Patients

Patients were 18 to 75 years of age, with a diagnosis of BE (without dysplasia), with histopathology reconfirmation of the diagnosis within 6 months of enrollment.

Results

In the dosimetry phase, 32 patients (29 men; mean age, 56.8 years) were enrolled. Median symptom scores returned to a score of 0 of 100 by day 3. There were no dose-related serious adverse events, and the outcomes at 1 and 3 months permitted the selection of 10 J/cm² (×2) for the subsequent effectiveness phase of the study. In the effectiveness phase, 70 patients (52 men, 18 women; mean age, 55.7 years) were enrolled. Median symptom scores returned to a score of 0 of 100 by day 4. At 12 months (n = 69; mean, 1.5 sessions), a CR for BE was achieved in 70% of patients. There were no strictures and no buried glandular mucosa in either study phase (4306 biopsy fragments evaluated).

Conclusions

Circumferential ablation of nondysplastic BE by using this balloon-based ablation device can be performed with no subsequent strictures or buried glands and with complete elimination of BE in 70% of patients at 1-year follow-up.

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