Radiofrequency ablation in the GI tract-the "state of the art" in the Czech Republic and worldwide
Jan Martínek Orcid.org 1,2, Přemysl Falt Orcid.org 3, Jan Gregar Orcid.org , Štěpán Suchánek Orcid.org 4, Ondřej Urban Orcid.org 5,6, Vlastimil Procházka Orcid.org 7, Miroslav Zavoral Orcid.org 4
1 Klinika hepatogastroenterologie, Transplantcentrum, IKEM, Praha
2 Gastroenterologická a endoskopická ambulancia, Interná klinika FZaSP TU a FN Trnava, Slovenská republika
3 II. interní klinika – gastroenterologická a geriatrická, LF UP a FN Olomouc
4 Interní klinika 1. LF UK a ÚVN – VFN Praha
5 II. interní klinika – gastroenterologie a geriatrie LF UP a FN Olomouc
6 Katedra interních oborů, LF UK v Hradci Králové
7 II. interní klinika – gatroenterologická a hepatologická LF UP a FN Olomouc
Radiofrequency ablation (RFA) is a new and effective treatment modality for ablative therapy in the gastrointestinal tract. Barrett's oesophagus (BE) is the most frequent indication for RFA. RFA is clearly indicated in patients with BE and high-grade dysplasia (HGD) or in patients after endoscopic resection (ER) of an early adenocarcinoma to ablate residual metaplastic mucosa. RFA is not routinely indicated in patients with BE and low-grade dysplasia (LGD) or in patients with non-dysplastic BE even though it can exceptionally be applied in these patients. RFA and endoscopic resection (ER) of the oesophagus can be mutually combined and can suitably complement each other. ER usually precedes RFA, however, it can also be performed after RFA, if necessary (e.g. if a visible lesion develops after RFA). RFA can also be indicated in patients with squamocellular neoplasias of the oesophagus, in patients with resistant and symptomatic GAVE syndrome (gastric antral vascular ectasia) or in patients with refractory postradiation colitis. In contrast to BE patients, these indications are not yet well established. In the Czech Republic, there are three RFA centres which offer this treatment modality-the Central Military Hospital in Prague, Vítkovice Hospital and the University Hospital in Olomouc. The treatment has not yet been approved or reimbursed. Thus, it is covered using the centres' resources. The treatment began in 2009 and since then, 58 patients have started RFA, of which 24 have completed the treatment. The majority of patients suffered from BE with HGD without any visible lesion or they had undergone prior endoscopic resection for an early adenocarcinoma. There are not many patients indicated for RFA treatment, at least at present. Therefore, three RFA centres seem appropriate for the Czech Republic, enabling the treatment of all patients with a clear indication. However, the reimbursement issue remains to be solved since the problem is not sustainable in the long term. The article summarizes the "state of the art" concerning RFA and also provides the treatment results from all three RFA centres in the Czech Republic. At the end, the authors discuss the subsequent scenario concerning RFA indications in the Czech Republic as well as abroad.
Keywordsadenocarcinoma, endoscopic resection
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