Thin-layer ablation of human esophageal epithelium using a bipolar radiofrequency balloon device

• Published in: Surgical endoscopy Vol. 20; no. 1; pp. 125 - 130
• Main Authors: DUNKIN, B. J, MARTINEZ, J, BEJARANO, P. A, SMITH, C. D, CHANG, K, LIVINGSTONE, A. S, MELVIN, W. S
• Format: Journal Article
• Language: English
• Published: New York, NY Springer 2006; Springer Nature B.V
• Subjects: Ablation; Adenocarcinoma - surgery; Aged; Aged, 80 and over; Biological and medical sciences; Biopsy; Cancer; Catheter Ablation - instrumentation; Catheters; Colon; Digestive system. Abdomen; Electrodes; Endoscopy; Energy; Epithelium - surgery; Equipment Design; Esophageal Neoplasms - surgery; Esophagectomy - methods; Esophagoscopy; Esophagus; Esophagus - pathology; Esophagus - surgery; Gastroenterology. Liver. Pancreas. Abdomen; General aspects; Humans; Investigative techniques, diagnostic techniques (general aspects); Male; Medical sciences; Middle Aged; Patients; Postoperative Period; Reoperation; Surveillance; Treatment Outcome; Tumors; United States; North America; America; United States > US; Prognosis; Esophageal disease; Male; Barrett esophagus; Esophagoscopy; Submucosa; Age; Gastric disease; Human; Premalignant lesion; Esophageal tumor; Device; Intestinal metaplasia-Barrett's-ablation; Esophagectomy; Malignant tumor; Method; Epithelium; Radiofrequency; Esophagus; Medicine; Treatment; Intestinal metaplasia; Digestive diseases; Esophagus adenocarcinoma; Comparative study
• ISSN: 0930-2794; 1432-2218
• DOI: 10.1007/s00464-005-8279-9

The goal of this study was to determine the optimal treatment parameters for the ablation of human esophageal epithelium using a balloon-based bipolar radiofrequency (RF) energy electrode. Immediately prior to esophagectomy, subjects underwent esophagoscopy and ablation of two separate, 3-cm long, circumferential segments of non-tumor-bearing esophageal epithelium using a balloon-based bipolar RF energy electrode (BARRX Medical, Inc., Sunnyvale, CA, USA). Subjects were randomized to one of three energy density groups: 8, 10, or 12 J/cm2. RF energy was applied one time (1x) proximally and two times (2x) distally. Following resection, sections from each ablation zone were evaluated using H&E and diaphorase. Histological endpoints were complete epithelial ablation (yes/no), maximum ablation depth, and residual ablation thickness after tissue slough. Outcomes were compared according to energy density group and 1x vs 2x treatment. Thirteen male subjects (age, 49-85 years) with esophageal adenocarcinoma underwent the ablation procedure followed by total esophagectomy. Complete epithelial removal occurred in the following zones: 10 J/cm2 (2x) and 12 J/cm2 (1x and 2x). The maximum depth of injury was the muscularis mucosae: 10 and 12 J/cm2 (both 2x). A second treatment (2x) did not significantly increase the depth of injury. Maximum thickness of residual ablation after tissue slough was only 35 microm. Complete removal of the esophageal epithelium without injury to the submucosa or muscularis propria is possible using this balloon-based RF electrode at 10 J/cm2 (2x) or 12 J/cm2 (1x or 2x). A second application (2x) does not significantly increase ablation depth. These data have been used to select the appropriate settings for treating intestinal metaplasia in trials currently under way.