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Authors

  1. Guy, Jennifer L. BS, RN, OCN

Article Content

I want to thank the authors for their comprehensive article, "Treating Barrett Esophagus with Radiofrequency Ablation" (January 2018), which discusses the potential for esophageal stricture, the most common complication of radiofrequency ablation (RFA).1 The incidence varies with the RFA technique, length of the area ablated, and concurrent procedures such as endoscopic mucosal resection. An incidence of 5.6% was reported in a recent meta-analysis.2

  
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Because esophageal stricture can be devastating for the patient, early identification is essential.3 Nurses must educate the patient about signs and symptoms to report to the healthcare team: dysphagia, aspiration or regurgitation of food or liquids, feeling of something "stuck" in the throat or chest, acid/bitter taste, heartburn, choking, shortness of breath, the inability to swallow pills and/or solid food, and unintended weight loss. High-volume aspiration due to stricture can cause chemical pneumonitis and infectious pneumonia, so aspiration must be reported immediately to avoid complications.4

 

Esophageal strictures can become progressively worse. Repeated dilations (with the risk of perforation) and steroid injections into the stricture may be required to restore esophageal patency.5 Protocols for ancillary personnel to identify signs and symptoms should be established to facilitate early recognition and intervention.6-8

 

-JENNIFER L. GUY, BS, RN, OCN

 

COLUMBUS, OHIO

 

REFERENCES

 

1. Orman ES, Li N, Shaheen NJ. Efficacy and durability of radiofrequency ablation for Barrett's esophagus: systematic review and meta-analysis. Clin Gastroenterol Hepatol. 2013;11(10):1245-1255. [Context Link]

 

2. Chadwick G, Groene O, Markar SR, Hoare J, Cromwell D, Hanna GB. Systematic review comparing radiofrequency ablation and complete endoscopic resection in treating dysplastic Barrett's esophagus: a critical assessment of histologic outcomes and adverse events. Gastrointest Endosc. 2014;79(5):718-731.e3. [Context Link]

 

3. Qumseya BJ, Wani S, Desai M, et al Adverse events after radiofrequency ablation in patients with Barrett's esophagus: a systematic review and meta-analysis. Clin Gastroenterol Hepatol. 2016;14(8):1086-1095. [Context Link]

 

4. Son YG, Shin J, Ryu HG. Pneumonitis and pneumonia after aspiration. J Dent Anesth Pain Med. 2017;17(1):1-12. [Context Link]

 

5. Baron TH. Management of benign esophageal strictures. Gastroenterol Hepatol (N Y). 2011;7(1):46-49. [Context Link]

 

6. Newton S. Tips on performing telephone triage. Clin J Oncol Nurs. 2006;10(4):524. [Context Link]

 

7. Guglielmo WJ. Telephone triage. Can your staff answer the call. Med Econ. 2007;84(3):34-38.

 

8. Gleason K, O'Neill EB, Goldschmitt J, Horigan J, Moriarty L. Ambulatory oncology nurses making the right call: assessment and education in telephone triage practices. Clin J Oncol Nurs. 2013;17(3):335-336. [Context Link]