Efficacy of Radiofrequency Ablation Combined With Endoscopic Resection for Barrett's Esophagus With Early Neoplasia  Roos E. Pouw, Katja Wirths, Pierre Eisendrath, Carine M. Sondermeijer, Fiebo J. Ten Kate, Paul Fockens, Jacques Devière, Horst Neuhaus, Jacques J. Bergman  Clinical Gastroenterology and Hepatology  Volume 8, Issue 1, Pages 23-29 (January 2010) DOI: 10.1016/j.cgh.2009.07.003 Copyright © 2010 AGA Institute Terms and Conditions

Figure 1 Flow-chart of the study protocol. ND-BE, nondysplastic Barrett's esophagus; EGD, esophagogastroduodenoscopy. Clinical Gastroenterology and Hepatology 2010 8, 23-29DOI: (10.1016/j.cgh.2009.07.003) Copyright © 2010 AGA Institute Terms and Conditions

Figure 2 Endoscopic images of circumferential RFA, complicated by nontransmural mucosal laceration. (A) C11M12 BE. (B) At 32 cm from the incisors a suspicious lesion was observed. (C) The lesion was removed in 2 pieces using multiband mucosectomy. Histology showed HGIN. (D) Before circumferential RFA, 6 weeks after ER, esophageal scarring was observed at the resection site. (E and F) During circumferential RFA, inflation of the balloon catheter caused nontransmural mucosal laceration, probably because of overstretching at the level of the ER scar. (G) Three months after primary circumferential RFA, 2 residual islands of Barrett's mucosa were detected with NBI. (H) The islands were treated with focal RFA. (I–L) Two months after the last ablation, complete endoscopic eradication of neoplasia and IM was reached, and the esophagus was covered with normal-appearing neosquamous epithelium, as seen with white-light endoscopy and NBI. Clinical Gastroenterology and Hepatology 2010 8, 23-29DOI: (10.1016/j.cgh.2009.07.003) Copyright © 2010 AGA Institute Terms and Conditions

Figure 3 Endoscopic images of a small island of glandular mucosa detected during the follow-up evaluation. (A and B) C9M10 BE with proximal reflux stenosis, containing diffuse HGIN after ER for early cancer. (C and D) Residual Barrett's mucosa was converted completely to neosquamous mucosa by 1 circumferential and 1 focal RFA. No recurrence of neoplasia or IM was found at the 2-month follow-up evaluation. (E and F) At the 6-month follow-up evaluation, however, NBI revealed a tiny island of columnar epithelium just distal to the reflux stenosis and the biopsy showed IM. Clinical Gastroenterology and Hepatology 2010 8, 23-29DOI: (10.1016/j.cgh.2009.07.003) Copyright © 2010 AGA Institute Terms and Conditions