Timely Treatment of Barrett's Esophagus Reduces Cancer Risk

Researchers at the University of North Carolina (Chapel Hill, USA) conducted a multicenter trial that randomly assigned 127 patients with dysplastic Barrett's esophagus to receive either radiofrequency ablation (ablation group) or a sham procedure (control group) in a 2:1 ratio. Tissue biopsies were obtained from the esophagus at regular intervals for one year after enrollment to assess for the presence of early Barrett's, dysplasia, and esophageal cancer. Comparison of the biopsy results at one year served as the primary outcome for the trial. The study endpoints were the eradication of all early Barrett's and, separately, all dysplasia in each group, as well as occurrence of new esophageal cancers.

The researchers found that among patients with low-grade dysplasia, complete eradication of dysplasia occurred in 90.5% of those in the ablation group, compared with 22.7% of those in the control group. Among patients with high-grade dysplasia, complete eradication occurred in 81% of those in the ablation group, as compared with 19% of those in the control group. Overall, 77.4% of patients in the ablation group had complete eradication of intestinal metaplasia, as compared with 2.3% of those in the control group. Patients in the ablation group also had less disease progression (3.6% versus 16.3%) and fewer cancers (1.2% versus 9.3%). Patients reported having more chest pain after the ablation procedure than after the sham procedure. In the ablation group, one patient had upper gastrointestinal hemorrhage, and five patients had esophageal stricture. The study was published in the May 28, 2009, issue of the New England Journal of Medicine (NEJM).

"Our results reported in the Journal are very promising, demonstrating superiority of ablation therapy for eliminating Barrett's and dysplasia, as well as reducing the rate of disease progression to more severe forms of dysplasia and esophageal cancer,” said lead author Nicholas Shaheen, M.D., an associate professor of medicine and epidemiology. "This and data from other recent trials may ultimately change the paradigm for how gastroenterologists manage their patients with this disease.”

As a result of chronic injury due to gastroesophageal reflux disease (GERD), the normal esophageal lining is replaced with abnormal cells (Barrett's tissue), predisposing the patient to a higher risk for developing cancer of the esophagus. Patients with Barrett's who develop cancer typically do so through a series of steps, starting with early Barrett's, then low-grade dysplasia or high-grade dysplasia, and then finally cancer.

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