American College of Gastroenterology
Advancing Gastroenterology, Improving Patient Care

Radiofrequency Ablation for Barrett’s Esophagus

Radiofrequency Ablation Overview

  • What is Radiofrequency Ablation?

    Radiofrequency ablation (RFA) is a procedure using high-energy radio waves to burn and destroy pre-cancerous cells. This method has been used to treat various conditions in different parts of the body, including precancerous conditions of the esophagus. Special devices are made to deliver the energy in different settings.

  • What is Barrett’s esophagus?

    Barrett’s esophagus is a condition in which the normal lining of the wall of the esophagus (the food pipe connecting the mouth to the stomach) is being replaced by cells similar to that of the small intestine due to acid reflux from the stomach. This is found in about 10 to 15 percent of patients with gastroesophageal reflux disease (GERD).

  • What is dysplasia?

    Dysplasia describes the presence of precancerous changes in the cells. The level of dysplasia tells how extensive the precancerous changes are.

    • No Dysplasia” means that the Barrett’s esophagus cells show no precancerous changes.
    • Low-Grade Dysplasia” means that the cells show some of the early characteristics of cancer.
    • High-Grade Dysplasia” means that the cells show more advanced changes of cancer. The worse the stage of dysplasia, the higher the risk that the Barrett’s esophagus will go on to become cancer.
  • Why do we need to treat Barrett’s esophagus when precancerous changes occur?

    Barrett’s esophagus does not generally “heal” itself or change back to normal tissue, even when it is being treated with the acid reflux medicines that stops heartburn. Medications such as omeprazole, esomeprazole, lansoprazole, pantoprazole, dexlansoprazole, and rabeprazole, which are commonly used for acid reflux, will not make Barrett’s esophagus go away. Barrett’s esophagus can progress into a precancerous state in a small percentage of patients. If these precancerous cells are not eliminated, they can further progress into esophageal cancer. Treatment of dysplasia with RFA in patients with Barrett’s esophagus has been shown to prevent esophageal cancer.

  • How does radiofrequency ablation cure Barrett’s esophagus?

    RFA uses heat energy to destroy the precancerous cells. The burned tissue sloughs off over 48 to 72 hours following the procedure. The patient is then treated with a high dose of proton pump inhibitor, a potent acid suppressive medicine, and an ulcer coating agent called sucralfate. Over a period of six to eight weeks, the area will be replaced by new, normal lining.

  • When do we consider RFA for Barrett’s esophagus?

    Guidelines from the American College of Gastroenterology published in 2015 recommend that all patients with high grade dysplasia be treated with RFA therapy. Patients with nodules, or bumps, in their Barrett’s may require removal of these bumps prior to treatment with RFA. This removal of nodules is known as endoscopic mucosal resection, or “EMR.” 

    For patients with confirmed low-grade dysplasia and without a short life expectancy, endoscopic therapy such as RFA is considered as the preferred treatment. In the case of low-grade dysplasia, another alternative to RFA is to continue to monitor the condition with endoscopies every 12 months, and only to perform the RFA treatments if the Barrett’s shows progression to high-grade dysplasia or early cancer. This is because low-grade dysplasia turns to cancer less frequently than high-grade dysplasia.

  • Should all patients with Barrett’s esophagus be treated with RFA?

    Because the progression of Barrett’s esophagus without dysplasia to esophageal cancer is very rare and the long-term benefit of treating these tissues to prevent esophageal cancer is not known; the ACG guidelines do not recommend the routine use of RFA in this situation. This is a very important point, and means that most patients who have Barrett’s esophagus will not require RFA, since most patients do not develop precancerous changes. 

  • How effective is radiofrequency ablation therapy?

    Overall, RFA completely removes Barrett’s esophagus and dysplasia in a high proportion of patients, as shown in results from multiple clinical studies. The success rate is about 80 to 90 percent. However, once the RFA removes the Barrett’s, there is no guarantee that it might not develop again down the road. In fact, over 10 percent of patients who are treated successfully for Barrett’s esophagus with RFA develop have Barrett’s again months to years after the first treatment.

    Fortunately, repeat treatments with ablation can eliminate these abnormal tissues entirely.  Because of the possibility that the Barrett’s can form again, your doctor will likely recommend that you have regular endoscopies even after you have been successfully treated.

What to Expect

Author(s) and Publication Date(s)

Ronald Hsu, MD, FACG, FACP, FRCP, Clinical Professor of Medicine, University of California, Davis, School of Medicine, Davis, CA – Published July 2019.


Shaheen NJ, Falk GW, PG Iyer et al: Diagnosis and Management of Barrett’s Esophagus. Am J Gastroenterol 2016; 111:30–50.

Shaheen NJ, Sharma P, Overholt BF et al: Radiofrequency ablation in Barrett’s esophagus with dysplasia with dysplasia. N Engl J Med 2009;360:2277-2288.

Orman ES, Li N, Shaheen NJ. Efficacy and durability of radiofrequency ablation for Barrett’s Esophagus: systemic review and meta-analysis. Clin Gastroenterol Hepatol 2013 Oct; 11(10):1245-55.

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