Ablation
Preventing Barrett's Oesophagus becoming cancer.
N.B. For the vast majority of us with Barrett's Oesophagus, this won't happen. In UK, with the highest incdence in the world, only 1 in 400 mutates to cancer each year. Over a lifetime, 90% will not progress to cancer. Those who are diagnosed will receive medication that probably reduces the risk, and regular surveillance scopes every few years to look for pre-cancerous changes.
If Barrett's cells ever show signs of mutating (dysplasia), it can be removed (ablated) as described on these pages.
Usually a combination of Endoscopic Mucosal Resection (EMR) and Radio Frequency Ablation (RFA), ablation is not recommended for non-dysplastic Barrett's as all treatments carry their own risks and, because Barrett's had formed initially, it's likely to form again so medication and surveillance are still required as before.
Endoscopic Mucosal Resection may be performed to remove all the "lumps and bumps".
In this video you can see the area in question is looks a little “lumpier” than the normal smooth lining.
He then sucks up this area into a special cap, which allows him to then place a small rubber band around the area.
He can then use a wire loop (called a snare) to remove the abnormal area using heat to cut through it.
N.B. There is no sound on the video.
(Copyright Drs Praful Patel and Phil Boger)
When there is a smooth area, the Barrett's cells may be burned away using Radio Frequency Ablation.
(RFA used to be referred to as "Halo" but that name was trademarked by another medical company.)
In this video you can see a guide wire being passed into the stomach and then the placement of the device which is then inflated so that it touches the Barrett’s lining, and then a burn is administered.
N.B. There is no sound on the video.
(Copyright Drs Praful Patel and Phil Boger)
This video further describes the procedure.
Used by permission. The use of any BARRX photo, image or video does not imply BARRX review or endorsement of any article, publication or website.
The Patient's Experience - Graham's Story
Friday was hello to HALO day!
Procedure itself was pretty straightforward. The procedure room was pretty full compared to a normal OGD. As well as my consultant and her usual two nurses we had an anaesthetist and his assistant and a couple of observers from the equipment suppliers who were sitting in for they day.
From my perspective the actual ablation was a piece of cake! The anaesthetist used propofol which, combined with some IV pain relief, meant I was in a full sleep phase throughout.
They managed to treat the full length (classed as C7M8) with a note on the report of "Good result".
Post procedure was pretty groggy for a while and had (my now usual) issues getting my BP back up. Once I could have fluids (+ 2hrs from procedure) it slowly came back up. So did an element of discomfort which, while in hospital, didn't get much past an ache.
Sent home at around 7pm with a bag full of meds and instructions for 24hr fluid diet followed by a progressing soft foods diet for the rest of this week.
Initially I think the anaesthetic had more effect on me than any post procedure symptoms. Almost felt a bit "fluey" for the next 18 hrs or so but that gradually cleared. Did get a bit more pain, mostly while swallowing the fluids and taking meds.
Saturday evening had some Tomato soup which worked ok. First major "problem" was an attempt at Chicken Noodle soup Sunday lunchtime which caused a bit more discomfort.
I have found scrambled eggs / light omelette pretty easy to tolerate but I can't go too far down that diet for obvious reasons. Been keeping up the calorie count with Lucozade Sport and chocolate milk. Must be doing pretty well at that since I've only dropped about 2kg over the last three days of no food / no solids.
Now have a two week set of meds consisting of;
Lansoprazole 30mg melting tabs twice daily
Dissolvable Paracetemol 2x500mg up to four times a day
Ranitidine in liquid form once a day before bed
A Gaviscon like liquid (can't remember the name) that I have to take four times a day to coat the oesophagus to assist healing
All taste pretty awful but that is par for the course I suspect.
Task now is to slowly push the diet forward without pushing the limits too hard.
Next event (as long as I don't develop a stricture - 1:20 chance) will be another HALO in September.