Faculty Bibliography

Purpose: Barrett's esophagus (BE) with high grade dysplasia (HGD) has the potential to progress to esophageal cancer if left untreated. Endoscopic ablation is an acceptable form of therapy oft en done with radiofrequency ablation (RFA). There is a subset of patients who continue to have persistent disease despite therapy and may benefit from low-pressure liquid nitrogen cryotherapy. Methods: A retrospective cohort of patients initially treated with RFA, but continued to have BE- HGD were analyzed in this study. Variables included patient demographics, initial BE length, total RFA sessions, degree of persistent BE after RFA, and results after cryotherapy. Results: A total of 12 patients were treated with RFA followed by cryotherapy for BE-HGD. The mean age was 69 years (range 53-84 years) and all were males. The mean BE segment was 5.6 cm (range 1-13 cm). In 25% (n=3) of BE-HGD patients endoscopic mucosal resection was done prior to ablation. The mean number of RFA sessions were 2.1 (range 1-4 treatments). In 11/12 (92%) patients BE-HGD persisted after RFA therapy based on biopsies. One patient was downgraded to BE without dysplasia. Patients were then treated with cryotherapy ablation for a mean of 2.3 treatments (range 1-5 treatments). Dosimetry freeze time had a mean of 19 seconds (range 10-30 seconds) repeated 2.6 cycles (range 2-4 cycles) per treatment session. Post cryotherapy biopsies of previous BE-HGD patients were available in 7/12 patients. Complete eradication of BE-HGD was seen in 4/7 patients and these patients were biopsy negative. Two patients only had BE without dysplasia and one patient was downgraded to low grade dysplasia based on biopsies. The remaining five patients demonstrated endoscopic improvement, but biopsies were still pending at time of analysis. Conclusion: There appears to be a subset of patients who fail RFA ablation for BE-HGD. Low pressure liquid nitrogen should be considered for refractory BE-HGD patients who fail RFA. Futures studies are needed to better define the role of cryotherapy for the endoscopic treatment of BE with dysplasia

GOALS: To measure esophageal wall thickness (EWT) with endoscopic ultrasound (EUS) in patients with and without Barrett's esophagus (BE). BACKGROUND: Segment length and histology are used to evaluate BE. The development of varying depths of ablation therapy has renewed interest in using EUS for BE. STUDY: In this prospective study, EWT measurements were taken from the balloon-mucosal interface to the outer most hyper-echoic line. These measurements were correlated with the highest grade of BE dysplasia and segment length, and then compared with the measurements from control group. RESULTS: Between 2004 to 2007, 76 BE patients (69 men, mean age 68 y, 4 ND, 14 low-grade dysplasia, 52 high-grade dysplasia, 6 carcinoma in situ) and 53 normal controls (18 men, mean age 60 y) underwent EUS. The mean EWT was 2.4 mm for controls, 3.1 mm for nondysplastic BE, 3.2 mm for low-grade dysplasia, 3.4 mm for high-grade dysplasia, and 3.9 mm for carcinoma in situ. In the control group of 53 patients, the mean EWT was 2.4 mm. Compared with normal controls, the mean EWT was significantly greater in all histologic subgroups of BE patients (P<0.001). No statistically significant correlation was seen between EWT and BE histology grade. There were no correlations between age, gender, or BE segment length and EWT (P=0.55). CONCLUSIONS: EWT is greater among patients with BE compared with control patients; however, there were no systematic differences in EWT were found among BE patients, based on histology and segment length.