What is HALO Radiofrequency Ablation (RFA)
HALO Radiofrequency ablation treatment is a new minimally invasive treatment for Barrett’s oesophagus. It has been developed in the last 10 years and was originally developed by a company called BARRX (hence the name). It can be used to treat Barrett’s oesophagus with dysplasia. It can also be used for Barrett’s oesophagus without dysplasia
When you should consider having Radiofrequency Ablation Treatment (RFA)
According to the UK National Institute for Health and Clinical Excellence (NICE), RFA should be offered to all patients with high grade dysplasia as a routine treatment. For patients with low grade dysplasia or non-dysplastic Barrett’s oesophagus, the evidence to support its use is much less clear. In these situations, the treatment should only be done within strict limits (read the NICE guidance).
For patients with high grade dysplasia, this treatment should only be carried out by experts in centres where large numbers of patients are treated. (see the NICE guidance). All our Barrett’s experts work in these specialist centres and are suitably experienced.
In 2013, the British Society of Gastroenterology (BSG) produced new guidelines on the management of Barrett’s oesophagus.
These new BSG guidelines
- Agree with the NICE guidance on when to use RFA.
- Extend the recommendation for RFA to include people with a strong family history of oesophageal cancer, even if they do not have high grade dysplasia themselves.
- For the first time anywhere in the world, recommend that RFA as the first line treatment for high grade dysplasia. Surgery (oesophagectomy) should now be reserved for those who fail RFA treatment
Success of HALO Radiofrequency Ablation Treatment
The crucial question is how successful is RFA?
In the original trials, success depended on what abnormality was being assessed:
- In people with non-dysplastic Barrett’s, the success at 2.5 year after treatment was over 98% eradication of the entire Barrett’s mucosa
- In people with low-grade dysplasia, success was over 90%
- In people with high-grade dysplasia was eradicated in 81%
- In patients with high-grade dysplasia, the Barrett’s oesophagus was also completely reversed to normal lining in around 75% of people.
Long Term Outcomes of HALO Radiofrequency Ablation Treatment
The UK HALO Registry
In the UK, Professor Lovat set up a national registry in 2007 to assess the long term success of this new treatment. Since 2011, he has been running this together with Dr Haidry). They published their initial findings in the most important international medical journal for Gastroenterology in 2013.
- The registry has now enrolled over 700 patients from around the UK.
- The vast majority of these patients have high grade dysplasia or early cancer arising in Barrett’s oesophagus
- The patients have been treated in over 20 hospitals.
- The UK outcomes are very similar to the original trials.
- About 85% of patients with high grade dysplasia in the UK are cleared of this at 12 months
- The success rate in the carefully chosen patients with early cancer is the same as high grade dysplasia
- About 70% of patients also have their entire Barrett’s oesophagus removed and returned to a normal lining
- The shorter the segment of Barrett’s oesophagus, the more successful the treatment
- Long term follow up suggests that more than 90% of successfully treated patients will remain fine
- In the few who relapse, further RFA treatment appears to be successful. Some of these people may also need EMR
- The likelihood of developing invasive cancer in this group of patients appears to be no more than 2% per year. This seems to be an 80% reduction compared to patients not being treated
Risks of Ablation Treatment
All medical treatments carry risks. The good news about this treatment is that the risks appear to be much lower than any of the alternatives.
- The risk of minor bleeding is around 1%
- The risk of major bleeding needing a blood transfusion is less than 1%
- The risk of developing a stricture, narrowing of the gullet, depends on what is wrong with the patient.
- In those with high grade dyplasia, the risk is around 6%
- In those will less severe abnormalities, the risk is lower
- The risk of making a hole (perforation) in the lining of the gullet is less than 1 in a thousand.
- To our knowledge, no-one has yet died as a direct result of this treatment. More than 20,000 procedures have been done world-wide.
What are the alternatives?
Not everyone is suitable for this treatment. Every case must be considered individually.
- For some people, oesophagectomy (surgical removal of the oesophagus/gullet) is needed
- For some people, chemoradiotherapy might be more suitable
- Occasionally, we would recommend laser treatment
- For some people, no treatment is required. This is very unusual but does happen sometimes.
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Please remember that BARRX HALO radiofrequency ablation treatment for dysplasia esophagus should be done by experts. We offer this service at our London clinic. If you would like an appointment,, please tell our office staff that you want to see a Barrett’s oesophagus expert. We will make sure you see the right person.