Endoscopic Ablation Therapy
Ablation is a medical term that means removal or eradication of tissue. Endoscopic ablation therapy is commonly performed for a precancerous condition called Barrett's Esophagus. Ablation therapy is a minimally invasive procedure that removes diseased cells in the mucosal layer of the esophagus. The removal is done by means of an endoscope and a treatment modality such as cryotherapy, photodynamic therapy or radiofrequency ablation.
The type of treatment chosen for patients is determined on a case-by-case basis, taking into consideration several factors, including how long the Barrett's segment is within the esophagus, the patient's own symptoms, and his or her capability for follow-up treatment. Patients undergoing treatment will also continue lifestyle changes and drug therapy for reflux (GERD) disease.
Cryotherapy — also referred to as cryo-ablation, cryosurgery or cryospray — is the use of extreme cold to destroy diseased tissue. Cryotherapy is often chosen by gastroenterologists because it allows them to reach difficult-to-treat areas within the esophageal lining. It is a relatively quick outpatient procedure for patients and has few side effects.
During the procedure, patients are first given a mild sedative. The gastroenterologist then gently maneuvers an endoscope down the esophagus. The endoscope contains a catheter and a miniature camera, which allows the gastroenterologist to view images of the diseased area on a video monitor.
Once the treatment area is identified, the gastroenterologist sprays liquid nitrogen or argon gas through the catheter at a low pressure onto the segment of the esophageal lining that has Barrett's esophagus. The frozen tissue is allowed to thaw and then is sprayed again. The treatment freezes and kills the diseased cells, allowing regeneration of new healthy cells. The procedure takes about 20 to 30 minutes. Several treatments over several months may be performed.
After the procedure, patients may experience minor swallowing difficulties for a few days. However, most patients are able to go back to work the following day. Patients have a regular follow-up visit with their gastroenterologist after the procedure.
Photodynamic therapy is the use of laser light in combination with a light-sensitive drug, called Photofrin, to destroy diseased tissue. Patients are given an injection of the light-sensitive drug two days before their treatment. The drug is then "taken up" in the diseased tissue. On the day of treatment, and after first receiving a mild sedative, the laser light at the end of an endoscope is applied to the area. The light activates the drug and kills diseased cells without affecting normal tissue. The treatment is done as an outpatient procedure and can be repeated as needed. It takes about 45 minutes.
Photodynamic therapy is used in patients with Barrett's esophagus with low- or high-grade dysplasia, and in patients with early or advanced esophageal cancer. Patients are able to eat a nearly normal diet within four to five days of treatment. Because a light-sensitive drug is used, patients must stay out of direct sunlight for four weeks after receiving this therapy.
Radiofrequency ablation is a treatment modality commonly used in cardiology to treat uncoordinated heartbeats, called tachyarrhythmias, as well as in other medical specialties. This same radiofrequency energy — similar to microwave energy — is used in Barrett's esophagus to destroy cells within the Barrett's tissue. After the patient has received a mild sedative, the gastroenterologist gently maneuvers an endoscope down the esophagus. The endoscope contains a catheter with an electrode at its tip and a small camera that sends images to a video monitor. When the area of the esophagus has been identified, the gastroenterologist directs the radiofrequency energy at the Barrett's segment to be treated. The heat energy destroys the diseased cells, leaving healthy tissue untreated.
This minimally invasive treatment takes about 30 minutes and patients are able to resume their normal activities the following day. Some patients experience minor swallowing discomfort for several days.