Radiofrequency Ablation Technique Considerations

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.

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

Read on for Details of How the Procedure is Done

Circumferential HALO-360 treatment procedure:

• 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)
• A special balloon unfurls and measures the diameter of the oesophagus. It only expands to the correct size needed for treatment.
• 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 three times in total.

Non-Circumferential HALO Treatment:

Some people start off with a segment of Barrett’s oesophagus which is easy to treat with a non-circumferential device.

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)
  • 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 three times. 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..

Once the treatment is completed, the patient goes home. Another treatment is offered around 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.

Some patients need more than 2 treatments. The longer the segment of Barrett’s oesophagus, and the less well the acid reflux is controlled, the more treatments that may be needed. Many people will need 3-4 treatments, and occasionally further interventions may be needed also.

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 an endoscopy 3 months after completing treatment to confirm success. The interval between repeat endoscopies then gets gradually longer, from 6 months, to 9  months to 1 year. We recommend yearly endoscopies for at least 5 years before returning to a 2-3 yearly surveillance protocol.

Radiofrequency ablation should only be done by experts. Please make sure that the doctor who treats you is very experienced with performing this treatment.