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• W4235961557 abstract "Shahidi and colleagues1Shahidi N. Arnout van Hattem W. Bourke M.J. Just relax: allowing the endoscopist and esophagus to “cool-off” between radiofrequency ablation applications affects stricture formation.Gastrointest Endosc. 2020; 91: 455-457Abstract Full Text Full Text PDF PubMed Scopus (1) Google Scholar suggest evaluating a regimen for radiofrequency ablation that uses the 360 Express, whereby the cleaning phase between ablations is replaced by a pause. This “relaxed” double-no-clean regimen may result in fewer strictures by letting the esophagus cool off between ablations, yet without the cumbersome cleaning and potentially risky reintroduction of the catheter. How we should practically proceed with this “relaxed” double-no-clean regimen, however, is not described. The first potential approach would be to leave the balloon in place after each ablation, allowing the esophagus to cool off and form submucosal edema. However, we should then wait at least a couple of minutes, which is about the time we buy with the cleaning step. After a couple of minutes, we can then ablate the same zone again, before moving distally for the next ablation, and proceeding in the same way throughout. This comes across as rather tedious. How long we should wait in between ablations is also not clear. Given the high risk of severe strictures in our study by the use of the simple-double-no-clean regimen,2Belghazi K. Pouw R.E. Koch A.D. et al.Self-sizing radiofrequency ablation balloon for eradication of Barrett's esophagus: results of an international multicenter randomized trial comparing 3 different treatment regimens.Gastrointest Endosc. 2019; 90: 415-423Abstract Full Text Full Text PDF PubMed Scopus (17) Google Scholar we are not very keen on experimenting with different cool-off intervals. The second potential approach would be to ablate the whole Barrett’s segment from proximal to distal, and then let the esophagus cool off before the second ablation pass. However, identifying the transition zone between adjacent ablations within the already ablated and uncleaned esophagus is very difficult. Not identifying this zone correctly could result in unnecessary overlap with a risk of stricture formation. Cleaning is therefore indispensable. So, although we understand the need to look into more simplified regimens for the 360 Express, the “relaxed” double-no-clean regimen is probably not the way to go, at least not for Barrett’s segments requiring multiple ablation zones. Staying relaxed is always advisable; yet, for stricture prevention, cooling down and cleaning are required in most cases. Dr Bergman is a consultant for Medtronic, Cook Medical, and Boston Scientific and the recipient of research support from Medtronic, Olympus Endoscopy, Cook Medical, Boston Scientific, Erbe Medical, C2 Therapeutic, and Ninepoint Medical. Dr Bisschops is a consultant for Medtronic, Pentax, Fujifilm, and Boston Scientific; the recipient of speaker’s fees from Medtronic, Pentax, and Fujifilm; and the recipient of research support from Pentax, Fujifilm, and Cook Medical. The other authors disclosed no financial relationships relevant to this publication. Just relax: allowing the endoscopist and esophagus to “cool off” between radiofrequency ablation applications affects stricture formationGastrointestinal EndoscopyVol. 91Issue 2PreviewOptimizing procedural efficacy is critical, given the imbalance between the demand for and availability of endoscopic resources. This need precipitated the development of a simplified circumferential radiofrequency ablation (RFA) regimen for Barrett’s esophagus, whereby the cleaning phase between RFA applications is omitted. A simplified regimen, with the use of traditional RFA catheters, is as effective at reducing the burden of Barrett’s esophagus but with a significant reduction in procedural time. Full-Text PDF" @default.
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• W4235961557 date "2020-02-01" @default.
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• W4235961557 title "Response" @default.
• W4235961557 doi "https://doi.org/10.1016/j.gie.2019.10.014" @default.
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