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Radiofrequency Ablation Technique Considerations

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Radiofrequency Ablation Technique Considerations

Radiofrequency ablation treatment is a new treatment for Barrett’s oesophagus. Read on if you would like to understand the technical steps for this treatment. If you prefer to read about why you might want this treatment.

RFA for Barrett’s oesophagus

The treatment is performed at endoscopy. It takes up to an hour to do and can be done under sedation. It does not require a full general anaesthetic.

There are different types of sedation. The usual drugs used are benzodiazepines such as midazolam together with strong pain killers such as fentanyl. These can be given by the endoscopist. They make the patient very sleepy. Most people will have no recollection of the treatment. Some people will, however, remember what is happening. This is particularly so for people who have had many previous endoscopies.

Other drugs such as propofol behave more like a general anaesthetic and put the patient to sleep. These are usually given by an anaesthetist. Patients wake up very quickly after this medicine is given and usually do not have the after-effects of full anaesthesia. Please discuss the type of sedative you are going to have with your doctor.

Most people will have the treatment done as a day-patient and will go home later the same day. For some people, it is better to stay in hospital overnight. This is decided on a case-by-case basis.

Different Types of RFA Treatment

There are two types of RFA treatment:

  • Circumferential.
    • A HALO-360 device is used for this.
    • This looks like a balloon with closely spaced rings on it.
    • Think of the rings as like the heated rear window of your car.
    • When the device is switched on, the rings heat up, just like the heated rear window. The difference is that the rings on the HALO device are heat up much faster and are only active for a couple of seconds.
  • Non-circumferential.
    • The devices used for this include the HALO-90, HALO-90 Ultra and HALO-60 devices
    • All these devices look like postage stamps – of slightly different sizes!
    • They are used to touch up any areas which have not been completely treated with a HALO-360 device

Circumferential HALO-360 treatment procedure:

The treatment involves these steps:

  • Clean the mucus which normally covers the lining the of the oesophagus. This is done most often with a spray called N-acetyl cysteine (NAC or Parvolex)
  • Use a special balloon to measure the diameter of the oesophagus. This varies along its length. It is very important to be sure what the minimum diameter is. This reduces the risk of causing damage during treatment
  • It is possible to do this step without having the endoscope inside. We think this is unsafe. So we recommend doing this step under direct vision
  • Once the minimum diameter of the oesophagus is known, the correct sized treatment balloon is chosen.
  • Once again, under direct endoscopic vision, the Barrett’s is treated. Each 3cm length is treated separately. It takes only 3 seconds to treat a 3cm segment. After treatment, the inner lining mucosa turns white.
  • After the first 3cm has been treated, the treatment balloon is moved further inside and the next 3cm is treated. It is perfectly safe to re-treat an area so we do not worry too much if there is a little overlap between treatments.
  • Once the whole of the Barrett’s oesophagus has been treated, the mucosa can be easily removed.
  • The entire treatment is repeated one more time.

Follow Up after Circumferential HALO Treatment

Once the treatment is completed, the patient goes home. Another treatment is offered 2-3 months later. Usually, the second treatment will be a non-circumferential method. This is because most of the Barrett’s will have already been eradicated. The next treatment is to remove any residual areas.

Non-Circumferential HALO Treatment:

This treatment is usually given after an initial HALO-360 treatment.

Some people start off with a short segment of Barrett’s oesophagus. This measures less than 3cm in length. These people may not need the HALO-360 treatment. They might start off with just a non-circumferential treatment.

Three different non-circumferential devices are available.

  • HALO 90
  • HALO 90 Ultra
  • HALO 60

All of these devices do the same thing. They treat small areas of residual Barrett’s oesophagus. The difference between them is simply the size of the area they can treat in one go.

Non-Circumferential HALO Treatment Procedure:

The treatment is very similar to HALO-360:

  • Clean the mucus which normally covers the lining the of the oesophagus. This is done most often with a spray called N-acetyl cysteine (NAC or Parvolex)
  • No balloon is needed to measure the diameter of the oesophagus as the treatment will not involve a balloon.
  • The treatment device is mounted on the end of the endoscope. Under direct endoscopic vision, the Barrett’s is treated. It takes only 2 seconds to treat a single segment. The area is treated twice. After treatment, the inner lining mucosa which has been treated turns white.
  • Once all the areas of residual Barrett’s oesophagus has been treated, the mucosa can be easily removed.
  • The entire treatment is repeated two more times. This double treatment was shown in research studies to be more effective than doing just a single treatment

Follow Up after Non-Circumferential HALO Treatment

Once the treatment is completed, the patient goes home. Another treatment may be offered 2-3 months later. Most people need 3 treatments. Some need more and some need less. At the last treatment, it is usual to treat the junction between with oesophagus and stomach again. This is because abnormalities often recur at this area.

Follow Up After Treatment

It is very important to do a follow up endoscopy to check that all abnormalities have been removed. We recommend taking biopsy samples from the entire area of the original Barrett’s oesophagus.

We cannot guarantee long term success. Long term follow up is therefore important. We currently recommend 3 monthly endoscopies for the first year after successful treatment. In the second year, we recommend 6 monthly endoscopies. After that, we recommend yearly endoscopies long term.

Radiofrequency ablation should be done by experts. We offer this service.If you would like an appointment, please phone 020 7183 7965 or email us on website@gastrolondon.org.uk Please tell our office staff that you want to see a Barrett’s oesophagus expert. We will make sure you see the right person.