Abstract
Radiofrequency ablation is a new and effective treatment modality for ablative therapy in gastrointestinal tract. Barrett´s esophagus (BE) is the most frequent indication for RFA.
RFA is clearly indicated in patients with BE with high grade dysplasia (HGD) or in patients after endoscopic resection of an early adenocarcinoma to ablate residual metaplastic mucosa. RFA is not routinely indicated in patients with BE and low grade dysplasia (LGD) and in patients with non –dysplastic BE even though it can be exceptionally applied in these patients.
RFA can be combined together with endoscopic resection (ER). ER usually anticipate the RFA, however, ER can be also performed after RFA, if necessary (e.g. if a visible lesion develop after the RFA).
RFA can also be indicated in patients with squamocellular neoplasias, in patients with other treatment resistant GAVE syndrome (gastric antral vascular ectasia) or in patients with refractory postradiation colitis. In contrast to BE patients, these indications are not well established yet.In the Czech Republic, there are three RFA centers which offer this treatment modality – Central Military Hospital in Prague, Vitkovice Hospital and University Hospital in Olomouc.
The treatment has not been approved and reimbursed yet. Thus, the treatment is paid using proper resources.
The treatment begun in 2009 and since then, 58 patients have started the RFA. A total of 24 patients have completed the treatment.
The majority of patients suffered from BE with HGD or they underwent a previous endoscopic resection for an early adenocarcinoma. There are not plenty of patients indicated for RFA treatment, at least at present.
Therefore, three RFA centers seem appropriate for the Czech Republic allowing a treatment to all patients with a clear indication. However, the reimbursement issue remains to be solved since the problem is not further sustainable.