(HealthDay News) — Radiofrequency ablation reduces the risk for neoplastic progression in patients with Barrett’s esophagus with low-grade dysplasia, according to a study published in the March 26 issue of the Journal of the American Medical Association.
K. Nadine Phoa, MD, from University of Amsterdam, and colleagues randomly assigned (1:1) 136 patients with Barrett’s esophagus containing low-grade dysplasia to endoscopic treatment with radiofrequency ablation (ablation) or endoscopic surveillance (control).
The researchers found that ablation reduced the risk of progression to high-grade dysplasia or adenocarcinoma by 25.0% (P < 0.001), and the risk of progression to adenocarcinoma by 7.4% (P = 0.03).
Complete eradication occurred in 92.6% of the ablation group for dysplasia and 88.2% for intestinal metaplasia, compared to 27.9% and 0% in the control group, respectively (P < 0.001).
There were significantly more treatment-related adverse events in the ablation group (19.1%; P < 0.001), with stricture being the most common (11.8%).
Early termination of the trial was recommended by the data and safety monitoring board due to superiority of ablation for the primary outcome and the potential for patient safety issues.
“In this randomized trial of patients with Barrett’s esophagus and a confirmed diagnosis of low-grade dysplasia, radiofrequency ablation resulted in a reduced risk of neoplastic progression over 3 years of follow-up,” the researchers wrote.
One author disclosed financial ties to the pharmaceutical industry.
In an accompanying editorial, Klaus Mönkemüller, MD, PhD, FASGE, of the University of Alabama at Birmingham, noted that these results suggest that ablation could be beneficial in clinical practice.
“The clinical trial by Phoa et al provides important evidence to support the use of radiofrequency ablation not only for patients with high-grade dysplasia and early cancer, but also for carefully selected patients [via screening and testing] with Barrett esophagus and confirmed low-grade dysplasia,” Mönkemüller wrote.
“A proactive endoscopic approach to eliminate dysplasia may result in reduced morbidity and mortality related to the progression of this disease.”
- Phoa KN, van Vilsterern FGI, Weusten BLAM, et al. Radiofrequency Ablation vs Endoscopic Surveillance for Patients With Barrett Esophagus and Low-Grade Dysplasia: A Randomized Clinical Trial. JAMA. 2014;311(12):1209-1217.
- Mönkemüller K. Radiofrequency Ablation for Barrett Esophagus With Confirmed Low-Grade Dysplasia. JAMA. 2014;311(12):1205-1206.