title: Stepwise circumferential and focal ablation of Barrett's esophagus with high-grade dysplasia: results of the first prospective series of 11 patients.
abstract: OBJECTIVE
  Stepwise circumferential and focal ablation of nondysplastic Barrett's esophagus has proven safe and effective. This study assessed the efficacy and safety of ablation for Barrett's esophagus with high-grade dysplasia (HGD), and residual Barrett's esophagus with dysplasia after prior endoscopic resection for visible lesions.
  
  
  METHODS
  This was a prospective cohort study. All visible abnormalities were resected prior to ablation. Persistence of dysplasia and absence of invasive cancer was confirmed with biopsies after endoscopic resection. A balloon-based electrode was used for primary circumferential ablation and an endoscope-mounted electrode was used for secondary focal ablation. Eradication of dysplasia and Barrett's esophagus was the main outcome measure.
  
  
  RESULTS
  Eleven patients (eight men; median age 60 years) were treated (median Barrett's length 5 cm). Visible abnormalities were removed with endoscopic resection in six patients. The worst pathological grade of residual Barrett's esophagus after endoscopic resection and prior to ablation was LGD (n = 2) and HGD (n = 9). Patients underwent a median of two circumferential and two focal ablation sessions. Complete remission of dysplasia and complete endoscopic and histological removal of Barrett's esophagus was achieved in 11/11 patients (100%). There were no adverse events or strictures, and in none of the 473 biopsies of neo-squamous mucosa was subsquamous Barrett's esophagus ("buried Barrett's") observed. During a median follow-up period of 14 months after the last treatment session and a median number of two follow-up endoscopies, none of the patients showed recurrence of dysplasia or endoscopic signs of recurrent Barrett's mucosa.
  
  
  CONCLUSIONS
  Stepwise circumferential and focal ablation appears to be a safe and effective treatment for complete removal of Barrett's esophagus containing HGD, and can be safely performed after prior endoscopic resection for endoscopically visible abnormalities.
authors.affiliation: Department of Gastroenterology, Academic Medical Center, Amsterdam, the Netherlands.
authors.forename: J J
authors.initials: JJ
authors.lastname: Gondrie
authors.forename: R E
authors.initials: RE
authors.lastname: Pouw
authors.forename: C M T
authors.initials: CM
authors.lastname: Sondermeijer
authors.forename: F P
authors.initials: FP
authors.lastname: Peters
authors.forename: W L
authors.initials: WL
authors.lastname: Curvers
authors.forename: W D
authors.initials: WD
authors.lastname: Rosmolen
authors.forename: K K
authors.initials: KK
authors.lastname: Krishnadath
authors.forename: F
authors.initials: F
authors.lastname: Ten Kate
authors.forename: P
authors.initials: P
authors.lastname: Fockens
authors.forename: J J
authors.initials: JJ
authors.lastname: Bergman
mesh_terms: D000368:Aged; D001471:Barrett Esophagus / Q000473:pathology / Q000601:surgery*; D017115:Catheter Ablation / Q000009:adverse effects / Q000379:methods*; D016145:Endoscopy, Digestive System; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D018365:Neoplasm, Residual; D011446:Prospective Studies; D012086:Reoperation; D016896:Treatment Outcome