Raphael KL, Trindade AJ. Management of Barrett’s esophagus with dysplasia refractory to radiofrequency ablation. World J Gastroenterol 2020; 26(17): 2030-2039 [PMID: 32536772 DOI: 10.3748/wjg.v26.i17.2030]
Corresponding Author of This Article
Arvind J Trindade, MD, Associate Professor, Director, Division of Gastroenterology, Long Island Jewish Medical Center, Zucker School of Medicine at Hofstra/Northwell, Northwell Health System, 270-05 76th Avenue, New Hyde Park, NY 11040, United States. arvind.trindade@gmail.com
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Minireviews
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Gastroenterol. May 7, 2020; 26(17): 2030-2039 Published online May 7, 2020. doi: 10.3748/wjg.v26.i17.2030
Management of Barrett’s esophagus with dysplasia refractory to radiofrequency ablation
Kara L Raphael, Arvind J Trindade
Kara L Raphael, Arvind J Trindade, Division of Gastroenterology, Long Island Jewish Medical Center, Zucker School of Medicine at Hofstra/Northwell, Northwell Health System, New Hyde Park, NY 11040, United States
Author contributions: Raphael KL performed data acquisition, drafted the manuscript and made critical revisions; Trindade AJ designed the outline, wrote the paper, made critical revisions, prepared the figures and tables, and gave final approval for publication.
Conflict-of-interest statement: There is no conflict of interest associated with any of the senior author or other coauthors contributed their efforts in this manuscript.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Arvind J Trindade, MD, Associate Professor, Director, Division of Gastroenterology, Long Island Jewish Medical Center, Zucker School of Medicine at Hofstra/Northwell, Northwell Health System, 270-05 76th Avenue, New Hyde Park, NY 11040, United States. arvind.trindade@gmail.com
Received: December 31, 2019 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 Processing time: 127 Days and 17.6 Hours
Abstract
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.
