HALO radiofrequency ablation for Barrett's
oesophagus
Patients with Barrett's Oesophagus are now
able to have Barrett's tissue removed in a short, safe endoscopic
procedure known as The HALO radiofrequency ablation.
HALO Radiofrequency
Ablation
This technology is developed to treat and
remove the diseased inner oesophageal lining without harming the
underlying healthy muscular wall of the oesophagus. HALO
radiofrequency ablation treatment is performed during a standard
endoscopy, which can be performed under sedation or light general
anaesthetic, and takes approximately 30 minutes. It is done as a
day case most patients do not need to remain in hospital.
Patients usually suffer chest discomfort and
difficulty swallowing for a week or two and some complain of nausea
for a few days. Occasionally patients need to be readmitted to
hospital for a couple of days in the week after treatment due to
difficulties swallowing.
Ablation of high-grade dysplasia in
Barrett's oesophagus
2% of patients develop this precancerous
change every year and once high grade dysplasia develops, the risk
of cancer in the next five years is around 50%. Eradication of
high-grade dysplasia prevents these patients from getting cancer.
Most patients require two to three treatments and a small number
may need more than this.
One in 12 patients develop a stricture or
narrowing of the oesophagus after treatment but this can be
resolved after the oesophagus is dilated (stretched) at a further
endoscopy.
Initial studies show that eradication rates of
high-grade dysplasia using Halo radiofrequency ablation are between
80 to 90% although the data are only available for two year follow
up. There will be long-term benefits by using Halo radio-frequency
ablation compared to the alternative methods, which already exist.
The National Institute for Health and Clinical excellence (NICE)
has approved the use of this treatment for this indication.
Sometimes, HALO radiofrequency ablation needs
to be combined with endoscopic mucosal resection (EMR). EMR is used
if there are visible nodules (swellings) in the lining of the
oesophagus. It may be done on the same day or on a different day to
the HALO treatment.
Patients with high grade dysplasia may require
advice regarding other established treatment options including
surgery and photodynamic therapy. For some people, it may not be
appropriate undergo any treatment at all, particularly if they are
elderly and have other illnesses. Patients should be certain that
Halo radiofrequency ablation is the appropriate treatment for them
before embarking on it. In particular, there is published
information from NICE regarding photodynamic therapy and patients
should read this before proceeding with any type of therapy for
high grade dysplasia.
Ablation of low-grade dysplasia or
non-dysplastic Barrett's oesophagus
In a number of studies, eradication rates for
Barrett's oesophagus in the region of 90% at 2 and now 5 year
follow-up. Most patients require between one and three treatments
with a small number needing more than this. A very small proportion
of patients developed a stricture (narrowing) of the oesophagus
after treatment but this resolved after the oesophagus was dilated
at a further endoscopy.
UK insurance companies have made it clear that
they will not pay for this treatment for eradication of Barrett's
oesophagus until NICE accepts that this is a valid treatment. This
is not likely to happen for the foreseeable future, because the
risk of developing oesophageal cancer is very low.
Recommended approach for patients with
non-dysplastic Barrett's oesophagus
At the moment patients with Barrett’s
oesophagus without dysplasia can only have Halo radiofrequency
ablation if they are prepared to pay for treatment themselves. The
cost of a single treatment is approximately £5,000. As most people
will need one to three treatments and at least one follow-up
endoscopy, the total cost is likely to be in excess of £15,000.
In addition, since we don't know the long-term
outcome, it is difficult to argue that patients who are currently
in a Barrett's surveillance programme should discontinue having
regular endoscopy because the risk of cancer has been abolished.
This is simply not yet known.
We are now for the first time in a position
where we may be able to more accurately assess an individual
person’s risk of developing cancer. We have pioneered a series of
special ‘biomarkers’ which predict future cancer risk with higher
accuracy than just the presence of ‘dysplasia’. We would be happy
to discuss these biomarker tests with you in more detail.
Patients with non-dysplastic Barrett's
oesophagus should continue to take their standard acid suppressing
medicine, to prevent symptoms of acid reflux. If they wish to
attempt to eradicate the Barrett's segment, the need to be aware
that the likelihood of success is in the region of 90 to 95%. If
the Barrett's is eradicated successfully, it still seems sensible
at the moment to recommend the same surveillance protocol as any
patient has not undergone Halo radio-frequency ablation. The value
of surveillance in Barrett's oesophagus, is, itself, a matter of
argument amongst specialists.
Information provided by Dr Laurence Lovat, Consultant
Gastroenterologist
The UK HALO Registry
The UK HALO Registry is a research registry which anonymously
records the outcomes of all patients with Barrett’s oesophagus
undergoing this treatment. We have already collected information on
over 300 patients undergoing the treatment in the UK. The
London Clinic is pleased to be one of the sites involved in this
Registry.
For more information about this study please visit http://www.treatbarretts.co.uk/
For more information about Barrett's oesophagus
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