Original Scientific Paper 366 Radiofrequency ablation of Barrett’s esophagus and early cancer within the background 1 3 Summary Background Barrett’s esophagus (BE) is the morpho- logical consequence of gastroesophageal relux disease (GERD). Via low- and high-grade dysplasia, nondysplas- tic Barrett’s esophagus (NDBE) may progress to cancer (0.1–0.6 % annual risk). We aim to summarize the im- pact of radiofrequency ablation (RFA) for the elimina- tion of BE and cancer prevention. Methods his PUB MED search included 136 papers on the pathophysiology, diagnosis, and therapy (RFA, antirelux surgery) of BE ≤ T1a. Results he relux of gastric acid and bile mediate a complex neurohumoral response within the esophageal mucosa, which orchestrates the formation of NDBE, dysplasia, and cancer. RFA efectively eliminates NDBE, dysplasia, and lat T1a cancer. Following 1–6 treatment sessions and 1–3.5 years follow-up, RFA for dysplastic BE efectively eliminates dysplasia and NDBE in > 80 and > 60 % of the cases, respectively, and mediates the devel- opment of a mucosa without genetic abnormalities. Af- ter 1–3 treatments for NDBE and 5 years follow-up, RFA eradicates NDBE in 92 % of the cases. NDBE expresses the genetic abnormalities of dysplasia and cancer and shares the same cancer risk as colonic polyps. herefore, within clinical trials, RFA for NDBE should be ofered to persons with NDBE and a risk proile, which predisposes them for cancer development (family history, GERD > 10 years, etc.). Antirelux surgery increases the yield of RFA for NDBE. Conclusions RFA (± endoscopic resection) is recom- mended for the elimination of BE with dysplasia and early cancer (T1a). Larger tumors are treated by surgi- cal resection. he biological and genetic properties of NDBE justify the examination of RFA for this indication within clinical trials. Future studies will have to eluci- date the combination of RFA, antirelux surgery, and medical therapy (PPI, statins, nonsteroidal antiinlam- matory drugs) for cancer prevention. Keywords: Acid, Bile salts, Barrett’s esophagus, Dyspla- sia, Esophageal adenocarcinoma, Gastroesophageal re- lux disease, Endoscopy, Radiofrequency ablation Introduction Gastroesophageal relux disease (GERD) results from abnormal relux of gastric content into the esophagus and afects 20–30 % of the population in North America and Europe [1]. Due to the symptoms, GERD impairs the life quality and productivity of the patients [2]. In addition, GERD alters the morphology of the esopha- gus. Columnar-lined esophagus (CLE) replaces the nor- mal squamous epithelium by the formation of cardiac mucosa (CM) [3, 4]. In a subgroup of patients, the CM includes goblet cells, this is intestinal metaplasia (IM) or nondysplastic Barrett’s esophagus (NDBE) [5–7]. Via a sequence involving low-grade dysplasia (LGD) and high-grade dysplasia (HGD), NDBE may progress toward esophageal adenocarcinoma [7, 8]. he reported annual cancer risk for persons with NDBE varies between 0.12 and 0.6 % [9–13]. A recent study found that the risk for those with NDBE to progress to HGD and cancer is 1.7 % [14]. NDBE, LGD, and HGD associates with a 200×, 560×, and 2.200× increased cancer risk, respectively, when compared with the normal population [15]. Surveillance is applied to lesions that follow a multistep progression Eur Surg (2012) 44:366–382 DOI 10.1007/s10353-012-0183-7 Radiofrequency ablation of Barrett’s esophagus and early cancer within the background of the pathophysiology of the disease I. Mesteri, L. Beller, S. Fischer-See, S. Schoppmann, J. Lenglinger, F. Wrba, M. Riegler, J. Zacherl M. Riegler · () · L. Beller · S. Fischer-See · S. Schoppmann · J. Lenglinger · J. Zacherl University Clinic of Surgery, Medical University Vienna, Vienna General Hospital, Währinger Gürtel 18–20, 1090 Vienna, Austria e-mail: franz.riegler@meduniwien.ac.at Ildiko Mesteri · F. Wrba Institute for Clinical Pathology, Medical University Vienna, Vienna General Hospital, 1090 Vienna, Austria Received: 14 May 2012 / Accepted: 31 October 2012 / Published online: 4 December 2012 © Springer-Verlag Wien 2012