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Healing of Mucosal Ablation Areas After Radiofrequency Ablation in Patients With Barrett’s Esophagus

Prateek Sharma, MD, FASGE reviewing Konda V, et al. Am J Gastroenterol 2022 Aug 12.

Endoscopic therapy for patients with neoplastic Barrett’s esophagus (BE) involves resection followed by mucosal ablation. Radiofrequency ablation (RFA) of the flat BE mucosa leads to the creation of a wound that heals with neosquamous mucosa. Mechanisms and the source of the neosquamous mucosa are unclear.  

In this prospective trial, 7 patients (6 men; mean age, 56.1±10.9 years; age range, 36-69 years) with nondysplastic long-segment BE underwent RFA treatment followed by mapping biopsies and volumetric laser endomicroscopy at 1-, 2-, and 4-week intervals. The areas of mucosal ablation were re-epithelialized by squamous mucosa from the proximal margin of the ablation and by islands of squamous cells that appeared to arise from the ducts of the esophageal submucosal glands. The proximal portion of the ablated area healed more quickly than the distal area, and it was noted in all cases that healing occurred in a patchy pattern. In 6 of the 7 treated patients, residual intestinal metaplasia was found in the form of submucosal intestinal metaplasia at the 2-week, 4-week, or both post-RFA intervals.


Comment:

Following RFA ablation in patients with BE, the neosquamous mucosa is generated from squamous cells from the proximal ablated edge and from ducts of the underlying esophageal submucosal glands. During this healing process of the ablated area, buried intestinal metaplasia below the neosquamous can occur.
Note to readers: At the time we reviewed this paper, its publisher noted that it was not in final form and that subsequent changes might be made.
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Prateek Sharma, MD, FASGE

Bio and Disclosures

Citation(s):

Konda V, Souza RF, Dunbar KB, et al. An endoscopic and histologic study on healing of radiofrequency ablation wounds in patients with Barrett's esophagus. Am J Gastroenterol 2022 Aug 12. (Epub ahead of print) (https://doi.org/10.14309/ajg.0000000000001940)