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Radiofrequency Ablation Eliminates Metaplasia in Dysplastic Barrett Esophagus
Radiofrequency ablation of Barrett esophagus tissue showing dysplasia completely eradicates metaplasia in three quarters of patients, according to a manufacturer-sponsored study in the New England Journal of Medicine.
Researchers in a multicenter trial randomized some 130 patients with dysplastic Barrett esophagus to either endoscopic radiofrequency ablation or a sham procedure. At 12 months, the proportion of patients with complete eradication of intestinal metaplasia was 77.4% in the ablation group and 2.3% in the sham group. Ablation patients with high-grade dysplasia, as well as those with low-grade dysplasia, showed significantly greater rates of complete eradication than the controls. The ablation group had a lower cancer rate than controls, but the number of cases was too small for meaningful statistical analysis.
Calling the study "a landmark" in the field, an editorialist writes that it's "still too early" to promote the procedure for patients with nondysplastic disease. (The editorialist reports receiving grant support from the device's manufacturer.)
LINK(S):
NEJM article (Free abstract; full text requires subscription)
NEJM editorial (Subscription required)
Journal Watch Gastroenterology summary (Subscription required)
Published in Physician's First Watch May 28, 2009
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