RFA for early esophageal neoplasia

The primary goal of endoscopic therapy for Barrett's esophagus (BE) with early esophageal neoplasia is to achieve complete eradication of the cancer and, for best long-term results, complete remission of the intestinal metaplasia (CR-IM). Radio frequency ablation (RFA) has become the mucosal ablation technique of choice, because of its improved side-effect profile and improvement in treatment efficiency. RFA is a thermal ablative modality that uses alternating electrical current to generate an electromagnetic field, which causes charged ions to rapidly oscillate and release thermal energy. Although surveillance biopsies are not included in the treatment protocol for RFA, it is proposed that failure to respond to RFA be defined by lack of improvement in the BE segment area and grade of dysplasia after two RFA sessions. Early esophageal neoplasia often presents with endoscopically visible mucosal irregularities (nodules) that can be targeted with endoscopic mucosal resection (EMR).