A case of mediastinitis after radiofrequency ablation for Barrett's esophagus

e a c n w s w s o d p s o m s ( A 67-year-old man with a 10-year history of nonnodular, long-segment Barrett’s esophagus (BE, C9M12) was noted to have high-grade dysplasia on surveillance endoscopy (EGD). After discussing the available treatment options (surgery vs endoscopic ablation), the patient decided to proceed with endoscopic treatment. EGD with EUS was performed first, the findings of which were negative for mediastinal adenopathy. Two weeks later, the patient underwent uneventful circumferential BÂRRX alo (BÂRRX Medical, Sunnyvale, Calif) radiofrequency blation (RFA) (12 J/300 W). Repeat EGD 6 weeks later revealed residual BE with Los ngeles (LA) grade B esophagitis in the previously ablated egments with partial neosquamous re-epithelialization. he second session of RFA was postponed until mucosal ealing could be documented. Surveillance biopsies at hat time revealed acute and chronic inflammation with eactive atypia consistent with “indefinite for dysplasia.” he patient was maintained on a proton pump inhibitor wice daily. Four weeks later or 10 weeks after the initial FA, repeat EGD revealed persistent LA grade B esophgitis in the distal esophagus (36-40 cm), neosquamous e-epithelialization (33-36 cm), and islands of residual BE 29-33 cm). Focal RFA of the proximal residual BE segment 29-33 cm) using the BÂRRX Halo system was performed (12J/40W). A total of 30 ablations were performed. There were no immediate complications, and the patient was discharged home without any symptoms. Several hours