title: Single-session endoscopic resection and focal radiofrequency ablation for short-segment Barrett's esophagus with early neoplasia.
abstract: OBJECTIVE
  The management of early neoplasia in Barrett's esophagus (BE) requires endoscopic resection of visible lesions, followed by radiofrequency ablation (RFA) of the remaining BE. We evaluated the safety and efficacy of combining endoscopic resection and focal RFA in a single endoscopic session in patients with early BE neoplasia.
  
  
  METHODS
  This was a retrospective analysis of patients with early BE neoplasia and a visible lesion undergoing combined endoscopic resection and focal RFA in a single session. Consecutive ablation procedures were performed every 8 to 12 weeks until complete endoscopic and histologic eradication of dysplasia and intestinal metaplasia were reached.
  
  
  RESULTS
  Forty patients were enrolled, with a median C1M2 BE segment, a visible lesion with a median diameter of 15 mm, and invasive carcinoma in 68% of cases. Endoscopic resection was performed by using the multiband mucosectomy technique in 80% of cases, and the Barrx(90) catheter (Barrx Medical, Sunnyvale, Calif) was used for focal ablation. When an intention-to-treat analysis was used, both complete remission of all neoplasia and intestinal metaplasia were 95% after a median follow-up of 19 months. Stenoses occurred in 33% of cases and were successfully managed with a median number of 2 dilations. In 43% of patients, 1 single-session treatment resulted in complete histologic remission of intestinal metaplasia.
  
  
  CONCLUSIONS
  Combining endoscopic resection and focal RFA in a single session appears to be effective. Less-aggressive RFA regimens could limit the adverse event rates.
authors.affiliation: Department of Gastroenterology, Academic Medical Center, Amsterdam, The Netherlands.
authors.forename: Maximilien
authors.initials: M
authors.lastname: Barret
authors.affiliation: Department of Gastroenterology, Academic Medical Center, Amsterdam, The Netherlands.
authors.forename: Kamar
authors.initials: K
authors.lastname: Belghazi
authors.affiliation: Department of Gastroenterology, Academic Medical Center, Amsterdam, The Netherlands; Department of Gastroenterology, St. Antonius Hospital, Nieuwegein, The Netherlands.
authors.forename: Bas L A M
authors.initials: BL
authors.lastname: Weusten
authors.affiliation: Department of Gastroenterology, Academic Medical Center, Amsterdam, The Netherlands.
authors.forename: Jacques J G H M
authors.initials: JJ
authors.lastname: Bergman
authors.affiliation: Department of Gastroenterology, Academic Medical Center, Amsterdam, The Netherlands.
authors.forename: Roos E
authors.initials: RE
authors.lastname: Pouw
mesh_terms: D000230:Adenocarcinoma / Q000150:complications / Q000473:pathology / Q000601:surgery*; D000368:Aged; D000740:Anemia / Q000628:therapy; D001471:Barrett Esophagus / Q000150:complications / Q000473:pathology / Q000601:surgery*; D016063:Blood Loss, Surgical; D001803:Blood Transfusion; D017115:Catheter Ablation / Q000379:methods*; D000069916:Endoscopic Mucosal Resection / Q000379:methods*; D004938:Esophageal Neoplasms / Q000150:complications / Q000473:pathology / Q000601:surgery*; D004940:Esophageal Stenosis / Q000453:epidemiology; D004945:Esophagoscopy / Q000379:methods; D005260:Female; D006760:Hospitalization; D006801:Humans; D008297:Male; D008875:Middle Aged; D060787:Neoplasm Grading; D009367:Neoplasm Staging; D009426:Netherlands; D011183:Postoperative Complications / Q000453:epidemiology; D012189:Retrospective Studies