Healing of Mucosal Ablation Areas After Radiofrequency Ablation in Patients With Barrett’s Esophagus

Endoscopic therapy for patients with neoplastic Barrett’s esophagus (BE) involves resection followed by mucosal ablation. Radiofrequency ablation (RFA) of the flat BE mucosa leads to the creation of a wound that heals with neosquamous mucosa. Mechanisms and the source of the neosquamous mucosa are unclear.  

In this prospective trial, 7 patients (6 men; mean age, 56.1±10.9 years; age range, 36-69 years) with nondysplastic long-segment BE underwent RFA treatment followed by mapping biopsies and volumetric laser endomicroscopy at 1-, 2-, and 4-week intervals. The areas of mucosal ablation were re-epithelialized by squamous mucosa from the proximal margin of the ablation and by islands of squamous cells that appeared to arise from the ducts of the esophageal submucosal glands. The proximal portion of the ablated area healed more quickly than the distal area, and it was noted in all cases that healing occurred in a patchy pattern. In 6 of the 7 treated patients, residual intestinal metaplasia was found in the form of submucosal intestinal metaplasia at the 2-week, 4-week, or both post-RFA intervals.