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Gastroenterology Research and Practice
Volume 2016, Article ID 4249510, 8 pages
http://dx.doi.org/10.1155/2016/4249510
Review Article

Outcomes of Radiofrequency Ablation for Dysplastic Barrett’s Esophagus: A Comprehensive Review

1Unit of Digestive Endoscopy, San Paolo Hospital, Via A. Di Rudiní, No. 8, 20142 Milano, Italy
2HPB Endoscopy, Royal Free Hospital, London, UK
3Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna, Italy
4Department of Medicine and Pharmacology, University of Messina, Hospital “G. Martino”, Via Consolare Valeria, 98124 Messina, Italy
5Department of Surgery, Unit of Hepatobilyopancreatic and Digestive Surgery, San Paolo Hospital, University of Milan, Via A. Di Rudiní, No. 8, 20142 Milano, Italy
6Unit of Digestive Endoscopy, Istituto Clinico Humanitas Mater Domini, Via Gerenzano 2, 21053 Castellanza, Italy

Received 25 August 2016; Accepted 24 November 2016

Academic Editor: Giovanni D. De Palma

Copyright © 2016 Carmelo Luigiano et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Barrett’s esophagus is a condition in which the normal squamous lining of the esophagus has been replaced by columnar epithelium containing intestinal metaplasia induced by recurrent mucosal injury related to gastroesophageal reflux disease. Barrett’s esophagus is a premalignant condition that can progress through a dysplasia-carcinoma sequence to esophageal adenocarcinoma. Multiple endoscopic ablative techniques have been developed with the goal of eradicating Barrett’s esophagus and preventing neoplastic progression to esophageal adenocarcinoma. For patients with high-grade dysplasia or intramucosal neoplasia, radiofrequency ablation with or without endoscopic resection for visible lesions is currently the most effective and safe treatment available. Recent data demonstrate that, in patients with Barrett’s esophagus and low-grade dysplasia confirmed by a second pathologist, ablative therapy results in a statistically significant reduction in progression to high-grade dysplasia and esophageal adenocarcinoma. Treatment of dysplastic Barrett’s esophagus with radiofrequency ablation results in complete eradication of both dysplasia and of intestinal metaplasia in a high proportion of patients with a low incidence of adverse events. A high proportion of treated patients maintain the neosquamous epithelium after successful treatment without recurrence of intestinal metaplasia. Following successful endoscopic treatment, endoscopic surveillance should be continued to detect any recurrent intestinal metaplasia and/or dysplasia. This paper reviews all relevant publications on the endoscopic management of Barrett’s esophagus using radiofrequency ablation.