In the not too-distant past, there was little doctors could do to safely remove unwanted tissue (such as scarring or precancerous cells) from the esophagus and other organs. Such tissue is a common problem with a condition called Barrett’s esophagus, which is a complication of chronic gastroesophageal reflux disease (GERD). Research shows that having Barrett’s esophagus slightly raises your risk of esophageal cancer.
“Chronic acid exposure from the stomach to the esophagus causes the normal cell lining there to change,” explains Harry Aslanian, MD, Yale Medicine's associate director of endoscopy. “This puts you at a slightly higher risk of developing esophageal cancer."
Now, however, an interventional endoscopy procedure called radiofrequency ablation (RFA) vastly improves the outlook for people who suffer from Barrett’s esophagus, which has developed dysplasiq (precancerous change). RFA employs heat to burn off diseased tissue. Numerous studies have proven its safety and efficacy. At Yale Medicine, RFA is one of several highly specialized endoscopic procedures our physicians regularly perform.
What is radiofrequency ablation (RFA)?
This technique employs highly calibrated heat energy to destroy precancerous (dysplastic) tissue in the esophagus, most commonly related to Barrett’s esophagus. Barrett’s esophagus is a complication of GERD, which causes a different type of cell (metaplastic) to line the lower esophagus.
RFA is designed to treat flat areas of precancerous tissue. For some patients, another procedure called endoscopic mucosal resection (EMR) may be required to remove raised or thickened tissue nodules prior to RFA. After RFA treatment, healthy, normal tissue will regrow to replace the abnormal cells in a majority of cases.
What should patients expect before, during and after an RFA procedure?
If you need to undergo RFA, you will be told not to eat or drink anything after midnight the night before your procedure. You will arrive at Smilow Cancer Hospital a half-hour before your scheduled procedure. A nurse will put an IV in your arm for sedation medication and hydration.
Anesthesia will be administered by a specially trained anesthesiologist. Once you are safely sleeping, your endoscopist will insert an endoscope through your mouth and into your esophagus and determine where the RFA treatment should be directed, while minimizing damage to healthy surrounding tissue. The procedure typically takes 45 to 60 minutes.
You will wake up in the recovery room and remain there for one to two hours. A companion must drive you home and we suggest that you rest for the remainder of the day. For the next 48 hours, you should continue to consume only liquids, and then limit yourself to a soft food diet for three to five days. Your doctor will prescribe medications to soothe chest discomfort and relieve any nausea that may occur after RFA.
What are the risks of RFA?
Endoscopy is a safe procedure. Only rarely—1 in 1,000 cases—does it cause complications. These can include reactions to the anesthesia medications, making a hole in the digestive wall and bleeding. There is also a small risk of esophageal stricturing (narrowing) after RFA, which may require an endoscopic procedure to relieve.
Far more often, however, RFA causes temporary discomfort to the chest, particularly after the initial treatment. This typically improves gradually over a five-day period.
What stands out about Yale Medicine’s approach to RFA?
At Yale Medicine, we handle your care with a multidisciplinary team of surgeons, oncologists, radiologists and pathologists. We work closely with referring physicians to promptly perform procedures, consultations and discuss management options.
As a group, we perform more than 2,000 complex endoscopies a year, making us among the largest of its kind in New England. We are trained in the latest, most advanced methods of diagnosing and treating complicated diseases of pancreas, bile duct and gastrointestinal tract. We are also actively involved in research, bringing our latest findings to patient care.