Evidence of Benefit
Radiofrequency Ablation in Dysplastic Barrett Esophagus
A randomized controlled trial  assessed whether, among persons with Barrett esophagus and dysplasia, radiofrequency ablation (vs. sham ablation) could eradicate dysplastic Barrett esophagus and decrease the rate of neoplastic progression. Among persons with low-grade dysplasia, eradication of dysplasia occurred in 90.5% of the treatment group compared to 22.7% in the control group; in the high-grade dysplasia group, rates were 81.0% compared to 19.0%. Additionally, 77.4% of persons in the ablation group had complete eradication of intestinal metaplasia, compared to 2.3% in the control group. Persons in the ablation group had less disease progression, and although cancer was not a primary outcome because expected numbers were small, there were fewer cancers in the ablation group (1.2% vs. 9.3%; P = .045). The complication rate was relatively low; among 84 treated persons, there was one upper gastrointestinal hemorrhage and five strictures that were easily treated.
This study suggests that treatment of Barrett with dysplasia may ablate Barrett esophagus and prevent disease progression, but the study provides only weak evidence (indeed, it was not designed to answer) about whether treatment reduces the outcome of esophageal cancer. Evidence from the study suggests that ablation does not simply coagulate and hide dangerous cells under the surface of the esophagus (those cells could later evolve to cancer). A question entirely separate from this study is whether patients should or should not be screened for Barrett esophagus (this study focused on treatment of persons with Barrett who had been identified as having dysplasia). Furthermore, the study does not discuss the net benefits and harms of an overall program of screening (e.g., of screening persons with gastroesophageal reflux disease (GERD) or certain GERD symptoms) and the surveillance of persons with Barrett. The potential for overdiagnosis and overtreatment may be considerable, if physicians used results of this study to treat persons with Barrett esophagus and no dysplasia.
- Oesophagus. In: World Cancer Research Fund., American Institute for Cancer Research.: Food, Nutrition and the Prevention of Cancer: A Global Perspective. Washington, DC: The Institute, 1997, pp 118-129.
- Muñoz N, Wahrendorf J, Bang LJ, et al.: No effect of riboflavine, retinol, and zinc on prevalence of precancerous lesions of oesophagus. Randomised double-blind intervention study in high-risk population of China. Lancet 2 (8447): 111-4, 1985.
- Muñoz N, Hayashi M, Bang LJ, et al.: Effect of riboflavin, retinol, and zinc on micronuclei of buccal mucosa and of esophagus: a randomized double-blind intervention study in China. J Natl Cancer Inst 79 (4): 687-91, 1987.
- Yang GC, Lipkin M, Yang K, et al.: Proliferation of esophageal epithelial cells among residents of Linxian, People's Republic of China. J Natl Cancer Inst 79 (6): 1241-6, 1987.
- Blot WJ, Li JY, Taylor PR, et al.: Nutrition intervention trials in Linxian, China: supplementation with specific vitamin/mineral combinations, cancer incidence, and disease-specific mortality in the general population. J Natl Cancer Inst 85 (18): 1483-92, 1993.
- Li JY, Taylor PR, Li B, et al.: Nutrition intervention trials in Linxian, China: multiple vitamin/mineral supplementation, cancer incidence, and disease-specific mortality among adults with esophageal dysplasia. J Natl Cancer Inst 85 (18): 1492-8, 1993.
- Corley DA, Kerlikowske K, Verma R, et al.: Protective association of aspirin/NSAIDs and esophageal cancer: a systematic review and meta-analysis. Gastroenterology 124 (1): 47-56, 2003.
- Shaheen NJ, Sharma P, Overholt BF, et al.: Radiofrequency ablation in Barrett's esophagus with dysplasia. N Engl J Med 360 (22): 2277-88, 2009.