Mucosectomy in Barrett’s Esophagus, Radiofrequency Applications

Barrett’s esophagus (also called Barrett’s epithelium or Barrett’s metaplasia) can be defined as the replacement of the epithelial tissue covering the inner surface of the esophagus by a tissue similar to the tissue lining the inner surface of the stomach and/or intestines (metaplasia).

It is more common in patients whose disease occurs at a young age, who have reflux symptoms during sleep, who have bleeding due to reflux, or who have narrowing at the lower end of the esophagus due to chronic reflux.

Barrett’s tissue can be seen during endoscopy, but endoscopic diagnosis alone is not reliable, histopathological examination should be performed by taking a tissue sample for definitive diagnosis (biopsy).

Before the development of cancer (precancerous) in the Barrett’s epithelium, there may be some changes called dysplasia that can only be detected by biopsy.

How Is Barret’s Esophagus Treated?

Drug therapy in Barrett’s esophagus cannot eliminate metaplasia, but the use of drugs that suppress gastric acid secretion in effective doses and surgical intervention in appropriate cases can reduce the risk of cancer development in the presence of Barrett’s esophagus.

Today, there are some endoscopic methods to eliminate and treat Barrett’s metaplasia (Argon plasma coagulation, photodynamic therapy (HALO) etc.). These methods can only be applied in experienced justifys and the effectiveness of these methods in preventing cancer is not certain.

Radiofrequency Ablation Treatment in Barrett’s Esophagus

Barret’s esophagus is histopathologically defined as the replacement of the mucosa at the lower end of the esophagus with specialized intestinal metaplasia tissue. This is a result of reflux. Traditionally, esophagectomy was performed in cases of Barret’s esophagus with high-grade dysplasia or intra-mucosal cancer, while endoscopic follow-up was recommended in cases with low-grade dysplasia or non-dysplastic Barret’s esophagus. Less invasive endoscopic treatments have been developed as both of these methods have their own disadvantages. Esophagectomy surgery had disadvantages such as high morbidity and mortality, and intermittent endoscopic screenings had disadvantages such as skipping cancer foci or inability to detect or detect late cancer development in the interim. The radiofrequency ablation method for Barret’s esophagus is a promising endoscopic method. Primarily, circular ablation is performed, and then the remaining tissue is incised, secondarily, with special devices through the endoscope. Compared to photodynamic therapy and argon plasma coagulation therapy, no residual Barret’s esophageal mucosa is visible in this method. In the first two methods, buried Barret’s esophagus foci can remain under the mucosa called “burried Barret’s esophagus”. Indications for radiofrequency ablation in Barret’s esophagus. In cases of Barret’s esophagus with intra-mucosal carcinoma or high-grade dysplasia, radiofrequency ablation can be performed after endoscopic mucosal resection or after the visible lesion has been treated with endoscopic mucosal resection. Radiofrequency ablation alone is not recommended. If there is submucosal involvement in the examination of the tissue taken after endoscopic mucosal resection, they may spread to the peripheral lymph nodes at a rate of 15-30%, these cases should be submitted to surgery. On the other hand, they are suitable candidates for radiofrequency ablation only in cases with intra-mucosal carcinoma. Radiofrequency ablation can be applied in these patients.