Background: The optimal management of patients with metaplastic and dysplastic lesions limited to the esophageal mucosa is controversial. BARRX ablation of Barrett’s esophagus is becoming increasingly used for lesions with evidence of dysplasia. The goal of this study was to review the utilization of BARRX ablation in patients being considered for anti-reflux surgery. Methods: This is a single center retrospective study analyzing the utilization of BARRX ablation in a busy surgical foregut practice. 20 patients underwent BARRX ablation of the esophagus from Jan 2006 until June 2008. Data collected included indications for procedure, number of ablations required to achieve complete ablation of Barrett’s esophagus, associated anti-reflux surgery performed, and short term follow up results.Results: Indication for ablation was intramucosal adenocarcinoma in 4 patients, high grade dysplasia in 8 patients, low grade dysplasia in 5 patients and long segment Barrett’s with no dysplasia in 3 patients. 5 patients had an associated nodule for which they underwent EMR prior to BARRX ablation (including the 4 patients with adenocarcinoma). 12/20 patients underwent anti-reflux surgery as a component of the treatment of their disease along with ablation of the Barrett’s esophagus. Of the remaining 8 patients, 5 were not surgical candidates due to medical comorbidities and the remaining 3 patients have anti-reflux surgery planned in the near future. 7 patients have undergone 1 treatment; 5 have undergone 2 ablations; 7 have had three ablations; and 1 patient has undergone 4 ablations. At a mean f/u of 1.2 years, 5 patients have completed therapy requiring a mean of 2.4 ablations (range 1-4) with no evidence of residual Barrett’s esophagus. 8 patients have undergone 3 or more ablations and 6/8 still have evidence of residual Barrett’s esophagus. 9 patients have undergone 1-2 ablation treatments and 7/9 need further treatments for persistent Barrett’s esophagus.Conclusions: BARRX ablation of Barrett’s esophagus with evidence of dysplasia is becoming an important adjunct to anti-reflux surgery. Treatment requires multiple ablative attempts as the majority of patients treated with 1 or 2 ablations still have evidence of Barrett’s esophagus. Longer term follow up is needed to determine the benefit of ablation.