Barrett’s esophagus and ablation treatment

Barrett’s esophagus (BE) is a metaplastic alteration of the normal esophageal epithelium that is detected on endoscopic examination and pathologically confirmed by the presence of intestinal metaplasia on biopsy. It affects mostly Caucasian males over the age of 50. The cellular change in the lining of the esophagus is thought to be caused by chronic injury due to gastroesophageal reflux disease (GERD). Its major significance is that it is a predisposing factor for esophageal adenocarcinoma. The cellular changes place the patient at a significantly increased risk for developing esophageal cancer, between 200 and 6,660 times that of the general population depending on the severity of the Barrett's diagnosis. Cancer of the esophagus carries a high mortality rate, is the seventh leading cause of cancer death in the U.S. and has displayed a rapid rise in annual incidence. In US, an estimated 3.3 million people have BE, although only 1 in 200 will develop cancer.

(inset source: Wikimedia Commons; (Endoscopic image of Barrett's esophagus with permission to place in public domain taken from patient — Samir धर्म 05:21, 17 May 2006 (UTC))

 

Current and Emerging Treatment Trends
Standard treatment for BE consists of treating the GERD and watching to see if the BE develops into esophageal cancer. However, according to a new study from the Mayo Clinic, BE can often be eliminated using endoscopic radiofrequency ablation (RFA), and most patients remain free of BE five years following the initial procedure.

In this prospective, multi-center trial conducted from May 2004 to November 2009, researchers performed endoscopic RFA, designed to burn away the abnormal Barrett's cells, in patients with intestinal metaplasia. For 50 RFA patients in whom BE had been eliminated at the two and a half year assessment, endoscopy was performed at five years. Results showed that 46 of the 50 remained free of BE, and four patients had low levels of residual disease that was eliminated in a single follow-up RFA session.

Applicable Ablation Technologies: Rationale for Use and Effect on Tissues
There are RF ablation devices currently on the market (Barrx Medical) which are intended for the treatment of Barrett’s esophagus. The HALO360 and the HALO90 Ablation Catheter use radiofrequency energy to ablate the irregular Barrett’s cells. The ablated tissue sloughs away, leaving behind a clean lesion.

Another product, currently in development, utilizes cryotherapy to achieve the same goal. According to C2 Therapeutics’ patent application, the company is developing a medical device for treating esophageal tissue which consists of a catheter, a balloon, which may be placed within the esophagus of the patient, and a refrigerant. The refrigerant is delivered into the interior of the balloon so as to place the balloon into an expanded, cooled state. The balloon can then press against and cool the esophageal tissue. The company is currently operating in stealth mode.

Source: MedMarket Diligence, LLC; Report #A145, "Ablation Technologies Worldwide".