Radiofrequency ablation in the GI tract – the “state of the art” in the Czech Republic and worldwide

Česká verzia

Authors: J. Martínek ¹; Přemysl Falt ² ; J. Gregar ³; Š. Suchánek ¹; O. Urban ²; V. Procházka ³ ; M. Zavoral ¹
Authors place of work: Interní klinika 1. LF UK a ÚVN Praha ¹; Centrum péče o zažívací trakt, Vítkovická nemocnice, a. s., Ostrava ²; II. interní klinika gastro-enterologická a hepatologická, FN Olomouc a LF UP v Olomouci ³
Published in the journal: Gastroent Hepatol 2011; 65(5): 279-285
Category: Digestive Endoscopy: Review Article

Summary

Radiofrequency ablation (RFA) is a new and effective treatment modality for ablative therapy in the gastrointestinal tract. Barrett’s oesophagus (BE) is the most frequent indication for RFA. RFA is clearly indicated in patients with BE and high-grade dysplasia (HGD) or in patients after endoscopic resection (ER) of an early adenocarcinoma to ablate residual metaplastic mucosa. RFA is not routinely indicated in patients with BE and low-grade dysplasia (LGD) or in patients with non-dysplastic BE even though it can exceptionally be applied in these patients. RFA and endoscopic resection (ER) of the oesophagus can be mutually combined and can suitably complement each other. ER usually precedes RFA, however, it can also be performed after RFA, if necessary (e.g. if a visible lesion develops after RFA). RFA can also be indicated in patients with squamocellular neoplasias of the oesophagus, in patients with resistant and symptomatic GAVE syndrome (gastric antral vascular ectasia) or in patients with refractory postradiation colitis. In contrast to BE patients, these indications are not yet well established. In the Czech Republic, there are three RFA centres which offer this treatment modality – the Central Military Hospital in Prague, Vítkovice Hospital and the University Hospital in Olomouc. The treatment has not yet been approved or reimbursed. Thus, it is covered using the centres’ resources. The treatment began in 2009 and since then, 58 patients have started RFA, of which 24 have completed the treatment. The majority of patients suffered from BE with HGD without any visible lesion or they had undergone prior endoscopic resection for an early adenocarcinoma. There are not many patients indicated for RFA treatment, at least at present. Therefore, three RFA centres seem appropriate for the Czech Republic, enabling the treatment of all patients with a clear indication. However, the reimbursement issue remains to be solved since the problem is not sustainable in the long term. The article summarizes the “state of the art” concerning RFA and also provides the treatment results from all three RFA centres in the Czech Republic. At the end, the authors discuss the subsequent scenario concerning RFA indications in the Czech Republic as well as abroad.

Key words:
Barrett‘s oesophagus – radiofrequency ablation – adenocarcinoma – endoscopic resection

Zdroje

1. Spechler et al. American Gastroenterological Association Medical Position Statement on the Management of Barrett’s Esophagus. Gastroenterology 2011; 140(3): 1084–1091.

2. Sharma P, McQuaid K, Dent J et al. A Critical review of the diagnosis and management of Barrett´s esophagus: The AGA Chicago Workshop. Gastroenterology 2004; 127(1): 310–330.

3. Shaheen NJ, Greenwald BD, Peery AF et al. Safety and efficacy of endoscopic spray cryotherapy for Barrett’s esophagus with high-grade dysplasia. Gastrointest Endosc 2010; 71(4): 680–685.

4. Martínek J, Zavoral M. Barrettův jícen – jak sledovat a jak léčit. Postrgrad Med 2009; 11(6): 674–682.

5. Bulsiewitz WJ, Pasricha S, Evan S et al. The Effect of Operator Experience On Treatment of Dysplastic Barrett’s Esophagus with Radiofrequency Ablation. DDW 2011. Sa1042.

6. Martínek J, Beneš M, Brandtl P et al. Low incidence of adenocarcinoma and high-grade intraepithelial neoplasia in patiens with Barrett´s esophagus: a prospective cohort study. Endoscopy 2008; 40(9): 711–716.

7. Schnell T, Sontag S, Chejfec G et al. Long-term nonsurgical management of Barrett´s esophagus with high grade dysplasia. Gastroenterology 2001; 120(7): 1607–1619.

8. Ell C, May A, Gossner L et al. Curative endoscopic resection of early esophageal adenocarcinomas. Gastrointest Endosc 2007; 65(1): 3–10.

9. Manner H, May A, Pech O et al. Early Barrett‘s carcinoma with „low-risk“ submucosal invasion: long-term results of endoscopic resection with a curative intent. Am J Gastroenterol. 2008; 103(10): 2589–2597.

10. Pouw RE, Wirths K, Eisendrath P et al. Efficacy of radiofrequency ablation combined with endoscopic resection for Barrett‘s esophagus with early neoplasia. Clin Gastroenterol Hepatol 2010; 8(1): 23–29.

11. Shaheen NJ, Sharma P, Overholt BF et al. Radiofrequency ablation in Barrett´s esophagus with dysplasia. N Engl J Med 2009; 360(22): 2277–2288.

12. Bulsiewicz WJ, Shaheen NJ. The role of radiofrequency ablation in the management of Barrett‘s esophagus. Gastrointest Endosc Clin N Am 2011; 21(1): 95–109.

13. Pouw RE, Gondrie JJ, Rygiel A et al. Properties of the neosquamous epithelium after RFA of Barrett esofagus containing neoplasia. Am J Gastroenterol 2009; 104(6): 1366–1373.

14. van Vilsteren FG, Pouw RE, Seewald S et al. Stepwise radical endoscopic resection versus radiofrequency ablation for Barrett‘s oesophagus with high-grade dysplasia or early cancer: a multicentre randomised trial. Gut 2011; 60(6): 765–773.

15. Pech O, Manner H, Ell C.Endoscopic resection. Gastrointest Endosc Clin N Am 2011; 21(1): 81–94.

16. Suchánek Š, Martínek J, Zavoral M. První radiofrekvenční ablace s využitím HALO systému v České republice. Čes a Slov Gastroent a Hepatol 2009; 63(4): 195–196.

17. Martínek J, Suchánek Š, Stefanová M et al. Radiofrekvenční ablace Barrettova jícnu. Současný stav a první vlastní zkušenosti. Folia Gastroenterol Hepatol 2009; 7(3–4): 105–111.

18. Falt P, Kajzrlíková I, Vítek P et al. Radiofrekvenční ablace v terapii časného spinocelulárního karcinomu jícnu. Endoskopie 2010; 19: 71–74.

19. Gregar J, Procházka V, Konečný M et al. Naše první zkušenosti s radiofrekvenční ablací Barrettova jícnu. Čes a Slov Gastroenterol Hepatol 2009; 63 (Suppl 1): 17.

20. Falt P, Urban O, Fojtík P et al. Radiofrekvenční ablace v terapii Barrettova jícnu – naše první zkušenosti. Endoskopie 2009; 18(3): 118–123.

21. Kajzrlíková I, Vítek P, Falt P et al. Recurrent oesophageal intramucosal squamous cell carcinoma treated by endoscopic mucosal resection and subsequent radiofrequency ablation using HALO system. BMJ Case Reports 2010; doi:10.1136/bcr.08.2010.3211.

22. Zhang YM, Bergman J, Weusten B et al. Radiofrequency ablation for early esophageal squamous cell neoplasia. Endoscopy 2010; 42(4): 327–333.

23. Urban O. Radiofrekvenční ablace Barrettova jícnu s dysplazií: Jak dlouho necháme naše pacienty čekat? Čes a Slov Gastroenterol Hepatol 2010; 64(3): 41–42.