Radiofrequency ablation for total Barrett's eradication: a description of the endoscopic technique, its clinical results and future prospects.

Stepwise circumferential and focal radiofrequency ablation using the HALO system is a novel and promising ablative modality for Barrett's esophagus. Primary circumferential ablation is performed using a balloon-based bipolar electrode, while secondary treatment of residual Barrett's epithelium is performed using an endoscope-mounted bipolar electrode on an articulated platform. It has been used as a single-modality treatment or in combination with other therapies. Recent studies suggest that this ablation technique is highly effective in removing Barrett's mucosa and its associated dysplasia without the known drawbacks of photodynamic therapy or argon plasma coagulation, such as esophageal stenosis and subsquamous foci of intestinal metaplasia (also known as "buried Barrett"). [nl]In this review paper we will explain the technical background of radiofrequency ablation using the HALO system, give a summary of its current status, and speculate on possible future applications.

[1]  J. Bergman1,et al.  Radiofrequency ablation for total Barrett’s eradication: a description of the endoscopic technique, its clinical results and future prospects , 2008 .

[2]  Kenneth J. Chang,et al.  Endoscopic ablation of Barrett's esophagus: a multicenter study with 2.5-year follow-up. , 2008, Gastrointestinal endoscopy.

[3]  L. Gossner,et al.  Long-term results and risk factor analysis for recurrence after curative endoscopic therapy in 349 patients with high-grade intraepithelial neoplasia and mucosal adenocarcinoma in Barrett’s oesophagus , 2008, Gut.

[4]  D. Chung,et al.  Pilot series of radiofrequency ablation of Barrett's esophagus with or without neoplasia. , 2008, Endoscopy.

[5]  D. Fleischer,et al.  A prospective pilot trial of ablation of Barrett's esophagus with low-grade dysplasia using stepwise circumferential and focal ablation (HALO system). , 2008, Endoscopy.

[6]  P. Fockens,et al.  Histologic evaluation of resection specimens obtained at 293 endoscopic resections in Barrett's esophagus. , 2008, Gastrointestinal endoscopy.

[7]  Kenneth J. Chang,et al.  213 A Randomized, Multicenter, Sham-Controlled Trial of Radiofrequency Ablation (RFA) for Subjects with Barrett's Esophagus (Be) Containing Dysplasia: Interim Results of the Aim Dysplasia Trial , 2008 .

[8]  P. Fockens,et al.  Complications Following Circumferential Radiofrequency Energy Ablation of Barrett's Esophagus Containing Early Neoplasia , 2008 .

[9]  S. Finkelstein,et al.  M1944 The Molecular Pathology of Radiofrequency Mucosal Ablation of Barrett's Esophagus , 2008 .

[10]  P. Fockens,et al.  Stepwise circumferential and focal ablation of Barrett’s esophagus with high-grade dysplasia: results of the first prospective series of 11 patients , 2008, Endoscopy.

[11]  P. Fockens,et al.  Effective treatment of early Barrett’s neoplasia with stepwise circumferential and focal ablation using the HALO system , 2008, Endoscopy.

[12]  Edward L. Lee,et al.  Bone marrow progenitor cells contribute to esophageal regeneration and metaplasia in a rat model of Barrett's esophagus. , 2008, Diseases of the esophagus : official journal of the International Society for Diseases of the Esophagus.

[13]  P. Fockens,et al.  Optimizing the Technique for Circumferential Ablation of Barrett Esophagus Containing High-Grade Dysplasia Using the HALO360 System , 2007 .

[14]  C. D. Smith,et al.  Endoscopic ablation of intestinal metaplasia containing high-grade dysplasia in esophagectomy patients using a balloon-based ablation system , 2007, Surgical Endoscopy.

[15]  N. Nishioka,et al.  Buried Dysplasia and Early Adenocarcinoma Arising in Barrett Esophagus After Porfimer-photodynamic Therapy , 2007, The American journal of surgical pathology.

[16]  Bergein F Overholt,et al.  Balloon-based, circumferential, endoscopic radiofrequency ablation of Barrett's esophagus: 1-year follow-up of 100 patients. , 2007, Gastrointestinal endoscopy.

[17]  D. Fleischer,et al.  Successful Ablation of Barrett Esophagus (BE) with Dysplasia Using the Halo360 Ablation System: A Single-Center Experience , 2006 .

[18]  P. Fockens,et al.  Stepwise Radical Endoscopic Resection Is Effective for Complete Removal of Barrett's Esophagus with Early Neoplasia: A Prospective Study , 2006, The American Journal of Gastroenterology.

[19]  Carissa A. Sanchez,et al.  Neosquamous Epithelium Does Not Typically Arise from Barrett's Epithelium , 2006, Clinical Cancer Research.

[20]  P. Fockens,et al.  Poor results of 5-aminolevulinic acid-photodynamic therapy for residual high-grade dysplasia and early cancer in barrett esophagus after endoscopic resection. , 2005, Endoscopy.

[21]  C. Buskens,et al.  Outcome of surgical treatment for early adenocarcinoma of the esophagus or gastro-esophageal junction , 2005, Virchows Archiv.

[22]  Michael Vieth,et al.  Curative endoscopic resection of early esophageal adenocarcinomas (Barrett's cancer). , 2005, Gastrointestinal endoscopy.

[23]  K. Batts,et al.  Complete ablation of esophageal epithelium with a balloon-based bipolar electrode: a phased evaluation in the porcine and in the human esophagus. , 2004, Gastrointestinal endoscopy.

[24]  E. Steyerberg,et al.  5-Aminolevulinic acid photodynamic therapy versus argon plasma coagulation for ablation of Barrett’s oesophagus: a randomised trial , 2004, Gut.

[25]  Masoud Panjehpour,et al.  Photodynamic therapy for Barrett's esophagus with dysplasia and/or early stage carcinoma: long-term results. , 2003, Gastrointestinal endoscopy.

[26]  L. Gossner,et al.  Local endoscopic therapy for intraepithelial high-grade neoplasia and early adenocarcinoma in Barrett's oesophagus: acute-phase and intermediate results of a new treatment approach , 2002, European journal of gastroenterology & hepatology.

[27]  J. Devière,et al.  Argon Plasma Coagulation in the Treatment of Barrett’s High-Grade Dysplasia and In Situ Adenocarcinoma , 2001, Endoscopy.

[28]  J. Goldblum,et al.  The diagnosis of low-grade dysplasia in Barrett's esophagus and its implications for disease progression , 2000, American Journal of Gastroenterology.

[29]  N. Buttar,et al.  Persistent genetic abnormalities in Barrett's esophagus after photodynamic therapy. , 2000, Gastroenterology.

[30]  A. Bhattacharyya,et al.  Long-term follow-up of intestinal metaplasia of the gastric cardia , 2000, American Journal of Gastroenterology.

[31]  P. Fockens,et al.  Pathology of early invasive adenocarcinoma of the esophagus or esophagogastric junction , 2000, Cancer.

[32]  M. Vieth,et al.  Ablation of Barrett's epithelium by endoscopic argon plasma coagulation in combination with high-dose omeprazole. , 2000, Gastrointestinal endoscopy.

[33]  I. Salmon,et al.  Intramucosal adenocarcinoma arising under squamous re-epithelialisation of Barrett's oesophagus , 2000, Gut.

[34]  H. Höfler,et al.  The molecular pathology of Barrett's esophagus. , 1999, Histology and histopathology.

[35]  W. Samowitz,et al.  Restoration of squamous mucosa after ablation of Barrett's esophageal epithelium. , 1993, Gastroenterology.

[36]  C. D. Smith,et al.  Thin-layer ablation of human esophageal epithelium using a bipolar radiofrequency balloon device , 2005, Surgical Endoscopy And Other Interventional Techniques.