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

B. J. Dunkin, J. Martinez, P. A. Bejarano, C. D. Smith, K. Chang, A. S. Livingstone, W. Scott Melvin

Research output: Contribution to journalArticle

122 Citations (Scopus)

Abstract

Background: 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. Methods: 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. Results: 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/cm 2 (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 μm. Conclusions: 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.

Original languageEnglish (US)
Pages (from-to)125-130
Number of pages6
JournalSurgical Endoscopy and Other Interventional Techniques
Volume20
Issue number1
DOIs
StatePublished - Jan 2006
Externally publishedYes

Fingerprint

Electrodes
Esophagectomy
Epithelium
Equipment and Supplies
Wounds and Injuries
Esophagoscopy
Metaplasia
Mucous Membrane
Adenocarcinoma

Keywords

  • Ablation
  • Barrett's
  • Esophagectomy
  • Esophagus
  • Intestinal metaplasia
  • Radiofrequency

ASJC Scopus subject areas

  • Surgery

Cite this

Thin-layer ablation of human esophageal epithelium using a bipolar radiofrequency balloon device. / Dunkin, B. J.; Martinez, J.; Bejarano, P. A.; Smith, C. D.; Chang, K.; Livingstone, A. S.; Melvin, W. Scott.

In: Surgical Endoscopy and Other Interventional Techniques, Vol. 20, No. 1, 01.2006, p. 125-130.

Research output: Contribution to journalArticle

Dunkin, B. J. ; Martinez, J. ; Bejarano, P. A. ; Smith, C. D. ; Chang, K. ; Livingstone, A. S. ; Melvin, W. Scott. / Thin-layer ablation of human esophageal epithelium using a bipolar radiofrequency balloon device. In: Surgical Endoscopy and Other Interventional Techniques. 2006 ; Vol. 20, No. 1. pp. 125-130.
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AU - Dunkin, B. J.

AU - Martinez, J.

AU - Bejarano, P. A.

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AU - Chang, K.

AU - Livingstone, A. S.

AU - Melvin, W. Scott

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AB - Background: 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. Methods: 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. Results: 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/cm 2 (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 μm. Conclusions: 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.

KW - Ablation

KW - Barrett's

KW - Esophagectomy

KW - Esophagus

KW - Intestinal metaplasia

KW - Radiofrequency

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