Non-thermal resection device for residual Barrett ablation in patient already treated by endoscopic submucosal dissection for initial esophageal neoplasia with high grade dysplasia

Endoscopic treatment of early Barrett's neoplasia has been established as a two-step approach [1]. In the first step, endoscopic resection for all visible neoplasia is performed. Endoscopic submucosal dissection (ESD) is globally accepted as a treatment for visible lesions, enabling a high rate of en bloc R0 resection [2]. In the second step, the ablation of all residual metaplasia is necessary to avoid the recurrence of neoplasia [1]. Thermal radiofrequency ablation (RFA) is currently used for this indication and obtains a significantly higher rate of complete eradication of metaplasia [3]. Despite RFA's success, however, there is a subset of patients in whom complete eradication of metaplasia cannot be achieved [3]. Recently some non-thermal procedures were proposed. Our device is a powered non-thermal resection device [3] [4] [5] associating a rotative blade with suction.