Radiofrequency ablation of Barrett's esophagus

Barrett's esophagus, a metaplastic change in the esophagus wherein normal squamous epithelium is replaced by specialized columnar epithelium, is a complication of chronic gastroesophageal reflux disease. There is an association between Barrett's esophagus and esophageal adenocarcinoma. Since 1977, esophageal cancer has increased by more than 500% in the United States. The optimal treatment for dysplastic Barrett's esophagus is unclear. One method for treating dysplastic Barrett's esophagus is radiofrequency ablation (RFA). RFA has been shown to effectively induce reversion to neosquamous tissue, and has been demonstrated in a randomized trial to significantly decrease the risk of progression of dysplasia to cancer. Minimal complications have been reported, and the technique can be performed in an outpatient setting. The aim of this article is to outline and discuss the technical aspects of performance of RFA. The basic principles of RFA and the rationale for adapting this technique to the esophagus will be briefly discussed. Next, the equipment and technique will be explained in detail, including suggestions for improved outcomes. Finally, potential complications, follow-up intervals, and expected outcomes will be addressed.