What is Barrett's oesophagus?
A common condition caused by chronic acid reflux (heartburn) which causes the normal cells that line the oesophagus (gullet) to turn into cells similar to the stomach. This is a pre-cancerous precursor to the development of oesophageal cancer.
The risk of Barrett's oesophagus progressing to oesophageal cancer is 0.5% per year. Changes in the Barrett's tissue (called dysplasia) increase this risk such that over 50% of patient will progress to cancer when dysplasia is present.
What is Radiofrequency ablation for Barret's oesophagus?
Radiofrequency ablation (RFA) is an established endoscopic treatment in which the Barrett's tissue is exposed to a defined heat energy to destroy the abnormal tissue.
RFA was first used to treat Barrett's oesophagus without dysplasia in 20051 and then subsequently used to treat both low and high grade dysplasia2.
More than 50 worldwide clinical studies, including several form the national UK RFA database3-6, have demonstrated the safety and long term effectiveness of RFA7 for complete removal of Barrett's as well as reducing progression to oesophageal cancer.
How does Radiofrequency ablation Work?
RFA for Barrett's oesophagus is performed in the endoscopy unit on a day case basis under sedation by an experienced gastroenterologist.
An electrode mounted on a balloon catheter (HALO 360) or an electrode placed directly onto the endoscope is placed into the oesophagus and used to deliver heat energy directly to the Barrett's lining of the oesophagus. The choice of HALO device is determined by the amount (length) of Barrett's that requires treatment.
The procedure typically takes 30 to 30 minutes and leads to ablation of the tissue. The treated tissue in the oesophagus sloughs off over the next 3-5 days following the procedure and over a period of 6-10 weeks this is replaced by normal (squamous) lining of the oesophagus.
What Preparation is Needed?
You will need to fast for 6 hours before the procedure although some medications can be taken with sips of water no later than 7am on the morning.
Blood thinning medications would need to be stopped prior to the procedure and this would be discussed in the clinic on an individual basis prior to RFA.
What is the Recovery Time and Follow Up?
This is a day case procedure and patients are discharged later the same day after having had something to eat and drink.
Patients are prescribed oral pain medications on discharge for 5 to 7 days (to be used if needed) and the doses of antacid (typically proton pump inhibitors such as Omeprazole) will be increased at this time for several weeks.
A modified soft diet is recommended for the first three days after the procedure to allow time for healing of the treated area and most patients can return to work 48 hours post treatment.
For most patients up to three treatment sessions are required to remove all the Barrett's lining but this is dependent upon the initial length of Barrett's needing ablation and the degree of Barrett's abnormalities on previous biopsy.
Following RFA treatment a repeat visit occurs at three monthly intervals until all the Barrett's has been eradicated. A follow up six months following completion of successful RFA would then be arranged with increasing intervals with each normal follow up examination.
Long term continuation of antacid therapy is recommended following successful RFA Barrett's eradication to prevent future new Barrett's development.
How safe is the procedure?
RFA is a very safe and well tolerated procedure. However, about 20% of patients will experience some chest pain following the procedure which resolves within a few days in the majority of cases.
About 3% of patients may develop a narrowing of the oesophagus (called a stricture) as a result of the healing process following RFA and this may occasionally require an endoscopy and stretching of the oesophagus called a dilatation.
Major complications are very uncommon (less than 0.1% of patents) but could include bleeding or perforation of the oesophagus.
1Endoscopic ablation of Barrett's esophagus: a multicenter study with 2.5-year follow-up. Fleischer DE et al. Gastrointest Endo 2008 Nov;68(5):867-76
2Radiofrequency ablation in Barrett's esophagus with dysplasia. Shaheen NJ et al. NEJM 2009 May 28;360(22): 2277-88
3Endoscopic ablation of Barrett's neoplasia with a new focal RFA device: initial experience with the HALO 60. Allen B et al. Endoscopy 2012 Jul;44(7):707-10
4Radiofrequency ablation and endoscopic mucosal resection for dysplastic Barrett's esophagus and early esophageal adenocarcinoma: outcomes of the UK National HALO RFA Registry. Haidry RJ et al. Gastroenterology 2013 Jul;145(1):87-95
5Improvement over time in outcomes for patients undergoing endoscopic therapy for Barretts: 6-year experience from the first 500 patients treated in the UK patient registry. Haidry RJ et al. Gut 2015 Aug;64(8):1192-9
6Comparing outcome of RFA ablation in Barretts with high grade dysplasia and intramucosal cancer: a prospective multicentre UK registry. Haidry RJ et al. Endoscopy 2015 Nov;47(11):980-7
7Endoscopic RFA for Barrett’s esophagus: 5-year outcomes from a prospective multicentre trial. Fleischer DE et al. Endoscopy 2010;42(10):781-9