Published online May 7, 2020. doi: 10.3748/wjg.v26.i17.2030
Peer-review started: December 31, 2019
First decision: April 1, 2020
Revised: April 8, 2020
Accepted: April 24, 2020
Article in press: April 24, 2020
Published online: May 7, 2020
Radiofrequency ablation (RFA) is very effective for eradication of flat Barrett’s mucosa in dysplastic Barrett’s esophagus after endoscopic resection of raised lesions. However, in a minority of the time, RFA may be ineffective at eradication of the Barrett’s mucosa. Achieving complete eradication of intestinal metaplasia can be challenging in these patients. This review article focuses on the management of patients with dysplastic Barrett’s esophagus refractory to RFA therapy. Management strategies discussed in this review include optimizing the RFA procedure, optimizing acid suppression (with medical, endoscopic, and surgical management), cryotherapy, hybrid argon plasma coagulation, and EndoRotor resection.
Core tip: This review highlights management strategies for patients with Barrett’s esophagus who are refractory to radiofrequency ablation therapy. A treatment algorithm is suggested that includes optimizing the radiofrequency ablation procedure, optimizing acid control, repeating radiofrequency ablation, and then using novel ablative or resection techniques for those patients with persistent refractory disease.