Use of a plastic endoprosthesis to successfully treat esophageal perforation following radiofrequency ablation of Barrett's esophagus.

摘要

Barrett's esophagus is a condition defined by the transformation of normal esophageal squamous epithelium to columnar epithelium containing goblet cells, known as intestinal metaplasia [1]. Barrett's esophagus is a known precursor to esophageal adenocarcinoma, a condition with increasing incidence [2,3]. Abnormal histologic changes in nondysplastic intestinal metaplasia may develop progressively, resulting in low grade dysplasia (LGD) or high grade dysplasia (HGD), prior to transforming into adenocarcinoma [4,5]. The progression to cancer is higher with HGD as opposed to nondysplastic Barrett's esophagus or LGD [6], As a result, this population has been targeted for endoscopic therapy in attempts to minimize the risk of cancer. Traditionally, treatment of these patients has been esophagectomy with reported risk of mortality estimated between 3% and 4%, even in experienced centers [7]. As such, less invasive endoscopic eradication therapies (EETs) have become increasingly popular, particularly for patients who are not good surgical candidates due to significant co-morbities, and more frequently as an alternative treatment for those who want to avoid esophagectomy. One such modality is endoscopic radiofrequency ablation (RFA), which has been shown to be effective in eradicating dysplastic changes in Barrett's esophagus [8]. Unfortunately, serious adverse outcomes of endoscopic therapy include bleeding, esophageal stricture and, less frequently, perforation [9],