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Austrian expert panel recommendation for radiofrequency ablation of Barrett’s esophagus

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Summary

Background

Barrett’s esophagus (BE) represents the premalignant manifestation of gastroesophageal reflux disease and includes columnar lined esophagus with intestinal metaplasia, low-grade dysplasia, high-grade dysplasia and cancer.

Methods

An Austrian panel of expert meeting was held at the Medical University Vienna, June 2015, to establish and define recommendations for the endoscopic treatment of BE with and without dysplasia and cancer. Recommendations are based on critical analysis of published evidence. Statistics were not applied.

Results

Diagnosis of cancer and dysplasia is to be reconfirmed by a second expert pathologist. Advanced cancer (> T1a) requires surgical resection ± adjuvant therapies. Treatment of T1a early cancer, high- and low-grade dysplasia should include endoscopic mucosal resection (EMR) and radiofrequency ablation (RFA). In the presence of increased cancer risk, BE without dysplasia should be treated by RFA within clinical studies only. Elimination of any early cancer, dysplasia and IM defines complete response, that is, post RFA histopathology shows squamous, cardiac or oxyntocardiac mucosa lined esophagus (Chandrasoma classification). Follow-up endoscopies are timed according to the base line histopathology. Down grade from cancer to dysplasia or from dysplasia to non-dysplastic BE defines partial response, respectively. Based on esophageal function testing, reflux is treated by medical or surgical therapy.

Conclusion

In Austria, RFA ± EMR is recommended for BE containing early cancer or dysplasia. Non-dysplastic BE with an increased cancer risk should be offered RFA within clinical trials to assess the efficacy for cancer prevention in this group of patients.

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Acknowledgments

The authors thank their patients for giving them the opportunity to learn about Barrett’s esophagus diagnosis and treatment. In addition, the authors express their gratitude to their supportive teachers, families and friends. May the open-minded approach continue to foster the development of future diagnosis and therapy of Barrett’s esophagus.

Conflict of interest

The authors declare that there are no actual or potential conflicts of interest in relation to this article.

Author information

Authors and Affiliations

  1. Department of Surgery, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria

    I. Kristo, S.F. Schoppmann MD & M. Riegler

  2. Department of Internal Medicine II, Barmherzige Brüder, Eisenstadt, Austria

    A. Püspök

  3. Department of General and Visceral Surgery, Krankenhaus Barmherzige Schwestern, Linz, Austia

    K. Emmanuel & G. Spaun

  4. Clinical Institute for Pathology, Medical University of Vienna, Vienna, Austria

    F. Wrba

  5. Department of Surgery, Landeskrankenhaus, Feldkirch, Austria

    E. Wenzl

  6. Department of Internal Medicine IV, Elisabethinen, Linz, Austria

    R. Schöfl

  7. Department of Gastroenterology and Hepatology, Medical University of Graz, Graz, Austria

    F. Schreiber

  8. Deparment of Internal Medicine, St. Elisabeth Krankenhaus, Vienna, Austria

    M. Häfner

  9. Department of Gastroenterology, Hepatology, Endoscopy and Oncology, Rudolfstiftung, Vienna, Austria

    C. Madl

Authors
  1. I. Kristo
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  2. S.F. Schoppmann MD
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Corresponding author

Correspondence to S.F. Schoppmann MD.

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Kristo, I., Schoppmann, S., Riegler, M. et al. Austrian expert panel recommendation for radiofrequency ablation of Barrett’s esophagus. Eur Surg 47, 319–323 (2015). https://doi.org/10.1007/s10353-015-0362-4

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  • DOI: https://doi.org/10.1007/s10353-015-0362-4

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