Endoscopic Submucosal Dissection Plus Radiofrequency Ablation Exhibits High Eradication Rates in Patients With Barrett’s Esophagus

Current strategies for the endoscopic treatment of Barrett’s esophagus (BE) focus on resection of nodular lesions within BE and then the ablation of the flat mucosal BE. The most commonly used resection method is endoscopic mucosal resection (EMR); however, endoscopic submucosal dissection (ESD) is increasingly being used in bulky lesions and when submucosal invasion is suspected. This study evaluated the safety and efficacy of ESD combined with radiofrequency ablation (RFA) for complete BE eradication.  

The retrospective study recorded patients with nodular BE treated by ESD and RFA during a 5-year period. Throughout this timeframe, 18 patients underwent a total of 22 ESDs with a median of 2 RFA treatment sessions per patient (interquartile range [IQR], 1.25-3). Patients underwent ESD over EMR primarily based on the size of the nodular lesion or for suspicion of esophageal adenocarcinoma. The median resection size was 12.1 cm2 (IQR, 5.6-20.2), and all patients included in the study received RFA after ESD. 

Over a median follow-up of 42.5 months (IQR, 28-59.25), complete eradication of dysplasia and intestinal metaplasia was achieved in 15 and 14 patients, respectively. During follow-up, 2 patients had recurrent dysplasia (13.3%) and 1 patient had recurrent intestinal metaplasia (7.1%). As for adverse events, 4 strictures (22%) and 1 intraprocedural microperforation (4.5%) were noted.