Non-thermal Resection Device for Ablation of Barrett's Esophagus - a Feasibility and Safety Study.

Background and study aims Several techniques exist for the eradication of Barrett's esophagus (BE); however, all have limitations regarding successful conversion to squamous epithelium and a complication profile. We aimed to assess the feasibility and safety of a new non-thermal device, the EndoRotor, for the eradication of BE as a first-line ablation technique. Patients and methods Patients with BE were prospectively included in 2 tertiary referral centers in The Netherlands. Inclusion criteria: BE-length 2-5cm, with low-grade dysplasia, high-grade dysplasia or residual BE after endoscopic resection (ER) of a lesion containing early neoplasia. Exclusion criteria: previous ER >50% circumference, or previous ablation therapy. Follow-up endoscopy was performed after 3 months. Outcomes were the percentage of endoscopically visible BE surface regression and complications. Results Thirty patients (25 male, age 66 years [IQR: 59-73], median BE C0M3) were included. Eighteen patients underwent ER prior to ablation. Median percentage BE ablated was 100% (IQR: 94-100). Median visual BE surface regression at three-months follow-up was 80% (IQR: 68-95). Multiple residual Barrett's islands were commonly seen. Six patients(20%) had a treatment-related complication requiring intervention, including one perforation(3%), one postprocedural hemorrhage(3%), and four strictures(13%). Post-procedural pain was reported in 18 patients(60%). Conclusions For the endoscopic ablation of BE, the EndoRotor procedure was found to be technically demanding with a longer procedure time compared to established ablation techniques and a high complication rate. Based on these results, we do not recommend the EndoRotor as a first-line ablation technique for the eradication of BE.