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Hépato-Gastro & Oncologie Digestive

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Radiofrequency ablation in the digestive tract Volume 27, issue 4, Avril 2020

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Authors
Sorbonne Université, Centre d’endoscopie, AP-HP, Hôpital Saint-Antoine, F-75012 Paris
* Correspondance

Radiofrequency ablation (RFA) is a treatment method used today in a variety of settings in the gastro-intestinal tract. Its efficacy has been proven or is currently being evaluated in diseases of the esophagus, stomach, biliary tract, pancreas and rectum. Its strong suit in gut afflictions resides in the ability it conveys to treat large target areas in a uniform fashion. In biliary and pancreatic diseases, it offers a minimally invasive alternative to surgery. Given proper training, its feasibility is excellent. Its efficacy on the other hand is variable. The efficacy of RFA has been proven in the setting of dysplastic Barret's esophagus, but data are scarce regarding squamous lesions of the esophagus. Regarding gastric vascular ectasia, RFA caries a significant cost burden and lacks efficiency as compared to band ligation. The use of RFA in biliary and pancreatic diseases is attracting more and more attention, specifically in non-operable patients in which treatment options are limited. However, a better understanding of the thermo-sensibility of the pancreas and the bile duct is warranted, as well as a better assessment of its efficacy. Finally, RFA is efficient in refractory hemorrhagic chronic radiation proctopathy (resistant to argon or formalin instillation). Performing RFA requires specific and costly equipment as well as an expertise, which limit its wider use.

Several key issues have emerged as research topics to determine the place of RFA in some of its more recent fields of application. First, the optimal settings (density, intensity, number of impacts) need to be determined. Second, the long-term efficacy needs to be better assessed. Finally, the cost-benefit balance should be evaluated.