Radiofrequency ablation, or RFA, is the best studied endoscopic ablation technology and has been used to treat Barrett’s esophagus since approximately 2003. It uses radiofrequency energy to heat and destroy, or ablate, the cells lining the surface of the esophagus. The depth of this ablation is about 500-700 microns, which allows for treatment of the surface lining cells without causing deep tissue injury. This minimizes but does not eliminate the risk of scarring or stricturing of the esophagus after the procedure. The procedure is highly effective in eliminating all Barrett’s esophagus (approximately 80% success rate in multiple published studies). The most common side effects are short-term post procedure pain (usually 3-5 days) and the development of strictures (between 5-10% of patients will experience this). Most patients will need 2-3 ablation sessions spaced 8-12 weeks apart to achieve complete eradication of their Barrett’s esophagus. Larger lengths of Barrett’s esophagus typically require an increased number of treatment sessions.
A variety of devices have been developed to perform RFA in the esophagus including balloon based devices that broadly treat the entire circumference of the esophagus in a given region or focal ablation devices that are passed through or attached to the end of the endoscope. This variety in devices used to perform the procedure has greatly aided in making the procedure highly effective and more efficient by minimizing the number of treatment sessions needed to achieve complete eradication of all Barrett’s esophagus tissue.