Radiofrequency ablation for Barrett’s oesophagus with dysplasia

Dysplasia in Barrett’s oesophagus signals an increased risk of progression to oesophageal adenocarcinoma, although it is not yet invasive cancer. Radiofrequency ablation (RFA) delivers controlled thermal energy to destroy abnormal epithelium, which can heal with neosquamous epithelium. The goal is complete eradication, not merely temporary clearing of a visible lesion. Learn more about リウマチ患者の皮下結節 皮下脂肪織炎の生検適応と病理所見の読み方.

Organised by the International Society for Diseases of the Esophagus, the 17th World Congress for Esophageal Diseases took place virtually from 27–30 September 2021, featuring scientific sessions, workshops and research abstracts. For Australian clinicians, this international exchange remains relevant as dysplastic Barrett’s oesophagus is managed through coordinated endoscopy, pathology and long-term surveillance.

Management begins with accurate diagnosis rather than ablation alone. Acid suppression, expert pathology, lesion characteristics and patient preferences determine whether RFA, endoscopic mucosal resection (EMR) or combined endoscopic eradication therapy is appropriate. This article supports informed discussion with a specialist team.

Why dysplasia changes management

Confirmed dysplasia changes management because the risk is no longer that of uncomplicated reflux or non-dysplastic Barrett’s. Treatment removes the tissue most likely to progress and allows histology to be reassessed after healing.

For a visible lesion suspicious for invasive cancer, EMR—sometimes endoscopic submucosal dissection—is generally preferred to obtain tissue for staging. Once any lesion is removed, RFA can treat the remaining flat Barrett’s segment. RFA alone may suit confirmed flat high-grade dysplasia managed by an experienced team.

Complete eradication does not end follow-up. Recurrence can develop at treated margins or elsewhere in the oesophagus, so surveillance remains part of care.

Confirming dysplasia before treatment

Before treatment, high-definition white-light endoscopy and chromoendoscopy should map the segment and target biopsy. A gastrointestinal pathologist with expertise in oesophageal dysplasia should confirm the grade; reflux-related inflammation or artefacts can otherwise lead to over-treatment.

Although it concerns subcutaneous nodules rather than oesophageal lesions, biopsy pathology interpretation illustrates why the indication for biopsy and its pathological findings should be considered together.

If dysplasia is indefinite, clinicians commonly optimise acid suppression, address reflux and repeat assessment before eradication. Confirmed high-grade dysplasia usually warrants prompt specialist management, while low-grade dysplasia requires careful discussion about risk, repeat confirmation and the benefits of treatment.

How radiofrequency ablation works

RFA is available as balloon-based circumferential ablation and focal ablation for smaller residual areas. The catheter applies radiofrequency energy while cooling or irrigation limits deeper tissue injury. Controlled thermal injury causes coagulation and replaces Barrett’s mucosa with neosquamous epithelium during healing.

Treatment is usually delivered over several sessions, often spaced four to eight weeks apart. Dysplastic areas may need repeat ablation, and early healing can look irregular, so endoscopic inspection and biopsy remain important rather than assuming every residual patch is residual cancer.

Weighing benefits and risks

Appropriate candidates have confirmed dysplasia and can complete follow-up. Important considerations include untreated coagulopathy, severe oesophageal dysmotility, active reflux oesophagitis, previous radiation injury and inability to take acid suppression after ablation.

Common effects include sore throat, chest discomfort and temporary dysphagia. Clinically important complications include bleeding, perforation and post-ablation stricture. Symptom severity, comorbidity and procedural expertise influence the balance between benefit and risk.

Long-term success depends on complete initial eradication, durable acid suppression and careful follow-up. Smoking, a large hiatal hernia, poor reflux control and missed surveillance visits are associated with recurrence or persistent disease.

Navigating care in Australia

Access in Australia is concentrated in metropolitan and tertiary services. Melbourne, Brisbane, Adelaide and Perth have public hospital endoscopy programs and private gastroenterology practices capable of RFA, while regional and rural patients may need interstate travel and accommodation.

Medicare supports diagnostic and therapeutic gastroenterology through the Medicare Benefits Schedule (MBS), but public procedures can involve waiting times. Private treatment may involve insurer gaps, and written estimates should clarify facility fees, planned sessions and pathology costs.

Local pathways also depend on repeat prescriptions, anticoagulation advice, specialist pathology and device availability. Australian pharmacies routinely supply proton pump inhibitors (PPIs); units offering RFA have the relevant catheter and generator, with training and protocol more important than brand preference.

Preparation, recovery and surveillance

Preparation should be multidisciplinary, involving the endoscopist, nurse, pathologist and referring clinician where appropriate.

Before the procedure

• Confirm the dysplasia diagnosis and review medications and allergies.
• Clarify PPIs, anticoagulants, diabetes medicines and fasting requirements.
• Arrange transport and instructions for chest pain, fever, bleeding or breathing difficulty.

After the procedure

• Take prescribed medicines according to the discharge plan.
• Allow several days for discomfort while following the prescribed diet and activity advice.
• Attend the agreed surveillance endoscopy and ensure pathology results are reviewed.

After complete eradication, surveillance intervals depend on the original dysplasia grade, treatment margins and local guidance; they are not fixed for every patient. In Australia, follow-up may be shared between a tertiary service and a local gastroenterologist, making secure result tracking essential.

Patients should also address reflux, weight, diet and smoking, as these influence healing and recurrence. Persistent heartburn, difficulty swallowing or recurrent reflux deserves review rather than simply another ablation session.

Planning the next clinical step

The evidence is strongest for specialist-led endoscopic eradication in carefully selected patients, but individual decisions still depend on pathology, anatomy and willingness to attend repeated follow-up. No dietary supplement or over-the-counter product can replace confirmed pathology, ablation and surveillance.

For a patient newly diagnosed with dysplastic Barrett’s oesophagus, the concrete next step is a gastroenterology consultation that includes review of the biopsy slides, repeat endoscopic mapping and a documented plan for endoscopic eradication therapy.