NEW YORK (Reuters Health) – In patients with Barrett’s esophagus, radiofrequency ablation (RFA) before or after anti-reflux surgery can reduce metaplasia and dysplasia, but whether the multi-treatment approach improves long-term outcomes remains unclear, researchers say.

“In theory, combining an antireflux procedure with mucosal ablation of Barrett’s changes should provide superior control of Barrett’s changes by eliminating or decreasing the high-risk metaplastic or dysplastic mucosa and decreasing further acid injury to the esophagus,” notes senior author Dr. Hiran C. Fernando, from Boston Medical Center, and his coauthors.

In an online paper January 14 in the Journal of Thoracic and Cardiovascular Surgery, Dr. Fernando’s team reports its initial experience in combining RFA and surgery in 14 patients with Barrett’s metaplasia (n = 11) or low-grade dysplasia (n = 3). The median patient age was 60 years.

RFA sessions were performed, as needed, 6 weeks before surgery. At 3 months postoperatively, RFA was repeated if necessary. On average, 2.6 ablation procedures were performed per patient, the authors note.

No patients died, but two complications — pneumonia and atrial fibrillation — occurred after the anti-reflux procedure. One patient had mild dysphagia that necessitated a single dilation 2 months after ablation.

The average length of Barrett’s esophagus fell from 6.2 cm to 1.2 cm after treatment (p = 0.001) and Barrett’s grade also dropped significantly. Also, the number of patients with circumferential disease fell from 13 to 1 after treatment.

As the number of RFA sessions increased, so did the likelihood of treatment success. Moreover, all patients who received three or more treatments had full resolution of Barrett’s metaplasia.

However, the median follow-up interval was only 17 months.

“Although we have demonstrated that this combined approach can be undertaken safely, the small number of patients and short follow-up cannot address the question of long-term success,” the researchers conclude.

“Further evaluation with larger controlled trials will be necessary to better define the success and durability of this approach for preventing progression to esophageal cancer,” they add.

Reference:
J Thorac Cardiovasc Surg 2010.