Barrett’s oesophagus eliminated when treated with ablation procedure

One in 10 Americans experiences heartburn at least once a week, and many dismiss the malady as a mere annoyance, choosing to swallow antacids and get on with their lives.

But what they don’t know can hurt them. Left untreated, the condition can lead to Barrett’s oesophagus, which in turn can put patients at risk for oesophageal cancer, one of the most deadly forms of cancer.

Now a multi-center clinical trial led by David E. Fleischer, M.D., Gastroenterology, Mayo Clinic in Arizona, has revealed promising results in treatment of Barrett’s oesophagus. The study, released today by BARRX Medical, Inc., finds that the 98.4 percent of patients with Barrett’s oesophagus were free of the disease 2 and 1/2 years later following non-surgical, endoscopic treatment with radiofrequency ablation.

In the procedure, the physician can ablate, or zap, abnormal tissue within the oesophagus. Called the HALO ablation system, two components are used to remove diseased tissue — one treats large, circumferential areas of the oesophagus, and the other component targets focal, non-circumferential disease.

Results were published online this month in Gastrointestinal Endoscopy, a leading scientific publication for gastrointestinal physicians and researchers.

In the clinical trial, eight U.S. centres enrolled 70 patients having intestinal metaplasia, which is the earliest stage of Barrett’s oesophagus. Because of an elevated risk for developing oesophageal cancer, patients with the disorder generally submit to a lifetime of endoscopic examinations (surveillance) to detect potential progression to more advanced stages of the disease — or cancer. The purpose of the study was to find out if this treatment could eliminate Barrett’s and possibly be an alternative to surveillance.

After treatment, patients in the trial were monitored for 2 and 1/2 years through regular endoscopic examinations to confirm if all of the diseased areas were eliminated. At the final evaluation, 98.4 percent of patients had achieved a complete response to therapy and had no remaining disease.

"This study represents an important step in understanding the best way to manage patients with Barrett’s oesophagus at the earliest phase of the disease and demonstrates that intestinal metaplasia can be eliminated," says Dr. Fleischer He went on to emphasise two points: (1) Since the majority of patients who have intestinal metaplasia do not go on to develop oesophageal cancer, most guidelines recommend surveillance for the first phase of Barrett’s, and (2) Elimination of Barrett’s does not eliminate acid reflux, which led to Barrett’s, so it must continue to be treated. He also added that ongoing trials continue to add to the body of knowledge about the ablation technique and its potential to reduce the risk of progression of the disease.

(Source: Gastrointestinal Endoscopy: Mayo Clinic: July 2008)