EMR is a technique in which superficial abnormal tissue is resected (removed) endoscopically from the deeper tissue layers. The abnormal tissue can then be sent to a pathologist for evaluation. Mucosal ablative techniques are methods of destroying the superficial lining, or “mucosa," of the gastrointestinal tract. This is usually done when there are precancerous changes which need to be treated. Once the superficial, diseased mucosal layer is destroyed, a new, healthy layer regenerates. A newer method of ablation is called radiofrequency ablation. One radiofrequency device has been developed specifically for ablation of Barrett’s esophagus. This is a cylinder shaped balloon passed over a guidewire. Once in position, the balloon is inflated, bringing its wall into contact with the precancerous Barrett’s mucosa. The physician presses a foot pedal and radiofrequency energy is delivered over the entire surface area of the balloon. The delivery of the energy takes about one second and results in a very superficial burn of the esophageal lining. Once the Barrett’s tissue sloughs off, a new, healthy esophagus lining grows back.
The study objective was to determine the efficacy and safety of EMR before RFA for nodular BE with advanced neoplasia (high-grade dysplasia or intramucosal carcinoma). It was a retrospective study conducted at the University of North Carolina Hospitals from 2006 to 2011. A total of 169 patients with BE with advanced neoplasia were included in the study: 65 patients treated with EMR and RFA for nodular disease and 104 patients treated with RFA alone for nonnodular disease. The main outcome measurements were efficacy (complete eradication of dysplasia, complete eradication of intestinal metaplasia, total treatment sessions, and RFA treatment sessions), and safety (stricture formation, bleeding, and hospitalization).
EMR followed by RFA achieved complete eradication of dysplasia and complete eradication of intestinal metaplasia in 94 percent and 88 percent of patients, respectively, compared with 82.7 percent and 77.6 percent of patients, respectively, in the RFA-only group. The complication rates between the two groups were similar: 7.7 percent vs 9.6 percent. Strictures occurred in 4.6 percent of patients in the EMR-before-RFA group compared with 7.7 percent of patients in the RFA-only group.