Barrett’s esophagus is a change in the cell type of the esophagus due to long-standing acid reflux disease (GERD). A patient who has Barrett’s esophagus increases their risk of developing esophageal adenocarcinoma (a type of cancer of the esophagus). It does this by the progression of cells through stages from normal to cancerous. These stages are called “dysplasia,” which refers to abnormalities of cells in the tissue that make it more disorganized and cancer-like. There is low-grade and high-grade dysplasia; low-grade dysplasia occurs when there are few abnormal cells found, and is an indication of a very early pre-cancerous condition, while high-grade dysplasia indicates more abnormal cells found and pre-cancer in its more advanced stages. The presence (and grade) of dysplasia is determined with biopsy of the segments of Barrett’s during an upper endoscopy, or EGD.
For patients wanting treatment for Barrett’s esophagus or severe acid reflux in Louisville, it is recommended that they be treated in order to eliminate the Barrett’s tissue. The most common method of accomplishing this is by RFA therapy.
What Is Involved in RFA?
RFA therapy uses radiofrequency energy (radio waves) to destroy diseased tissue while minimizing injury to the surrounding healthy tissue. The tissue is then removed through ablation. As the Barrett’s esophagus tissue is thin, it is a good candidate for easy removal using the RFA technique, which focuses onto the tissue a specific heat energy given in a highly-controlled, precise manner until it is no longer alive. This process uses HALO technology, which consists of one catheter capable of treating larger areas and one for effectively treating smaller areas of the esophagus.
The success rate for RFA therapy is high; studies have demonstrated long-term removal of Barrett’s esophagus in 80-90 percent of the patients treated. For some patients, it may take two to three separate sessions to destroy all of the Barrett’s tissue in the esophagus. Once destroyed, healthy tissue will grow in its place after three to four weeks.
How Do You Prepare for the Procedure?
Before undergoing RFA, your GHP physician will go over some pre-operative instructions that you will need to follow in the days before your procedure. Following these instructions is essential to limit surgery risks and provide the best results.
- Stop certain medications. Prior to surgery, your GHP physician and their staff will need to be made aware of all medications that you are taking, especially blood-thinning medications. These may include Coumadin (warfarin), Plavix (clopidogrel), Xarelto (rivaroxaban), Pradaxa (dabigatran), Eliquis (apixaban) and Lovenox (enoxaparin). Since the use of these medications increases the risk of excessive bleeding, they should be stopped prior to your procedure. If you are using insulin, the dosage or timing will also need to be adjusted the day of the procedure. Doctor-prescribed aspirin may be continued before your procedure. In addition, your GHP physician asks that you provide them or their staff with a list of medications to which you are allergic.
- Stop eating hours beforehand. Refrain from eating anything starting the midnight before your procedure is scheduled.
What Happens During RFA?
RFA is performed through an upper endoscopy, or EGD, procedure performed on an outpatient basis at Jewish Hospital in downtown Louisville. After you check in, you will be escorted to the “pre-op” area where an IV will be placed and nurses will take down your medical information. You will then meet with an anesthesiologist to discuss the sedation used for the procedure.
Next, you will be taken to a procedure room and connected to monitors that will monitor your blood pressure, heart rate and blood oxygen levels throughout the course of the procedure. Once this is finished, you will then be sedated for the duration of the procedure (not awakening until after it is complete). The procedure itself takes an average of 20-25 minutes to complete.
To prepare for the procedure, you will be placed on your left side, and a “bite block” will be inserted into your mouth (to prevent the endoscope from damaging your teeth as well as to prevent damage to the scope). The endoscope is then passed through your mouth and advanced into the esophagus, and the area of Barrett’s esophagus is evaluated carefully. If any visible abnormalities (nodular, raised, ulcerated areas) are seen within the section of Barrett’s esophagus, then an endoscopic mucosal resection (EMR) may be performed. If no abnormalities are found, then RFA will be performed using the HALO-360 balloon-catheter (used to treat a larger area of the esophagus) for the first treatment. For subsequent treatments, the HALO-90 is most commonly used. Under direct visualization of the balloon, it is inflated to make contact with the Barrett’s segment, and then heat energy (~1 second) is applied.
What Should You Expect after the Procedure?
After the RFA treatment, you will be returned to the “post-op” area to recover from sedation. During this time, you will be monitored for any potential complications from the procedure and/or sedation. When you are fully recovered, your GHP physician will give you an explanation of the findings from the procedure (this report is preliminary, however, and it may take several days before the final results of the biopsies or information regarding the polyps removed are complete). Along with the findings, your GHP physician will provide you with a copy of the procedure report, patient information handouts and follow-up instructions.
Due to the effects of sedation, patients are instructed not to drive, operate machinery or make important decisions for the 24 hours following your procedure. We recommend that you have someone drive you home after surgery. Your GHP physician recommends a clear liquid diet for the first two to three days after treatment. After that, you will be able to eat after you leave the hospital, unless instructed otherwise. The nursing staff will review these and other important post-op instructions with you prior to discharge.
All patients feel chest discomfort and difficulty swallowing for three to five days after RFA. Your GHP physician will provide prescriptions for pain medications, anti-nausea meds or local anesthetics to help with symptoms and promote healing. Patients will be required to take their proton pump inhibitor medication (Prilosec, Protonix, Nexium, Aciphex, Prevacid, or Dexilant) twice a day for 30 days.
Possible Complications and Risks
The most common complication from RFA treatment is the development of a stricture (narrowing) of scar tissue in the esophagus. This occurs in about 6 percent of cases and is treated with upper endoscopy and dilation (stretching).
A very rare but major complication is a perforation, or tear, in the lining of the esophagus. This complication occurs in less than 0.02 percent of cases, and some may require surgery to repair.
Uncommon risks from sedation used for EGD include reactions to sedation medications, possible aspiration of stomach contents into the lungs and complications from heart and lung diseases.
All of these risks must be balanced against the potential benefits of the procedure and the risks of alternative approaches to the condition.
Is RFA Therapy Right for You?
Would you like to know if you’re a good candidate for RFA and GERD treatment in Louisville? If you have this or other questions about this minimally invasive cancer treatment, your GHP physician is happy to provide you with the answers you need. Contact his office today for more information or to schedule an appointment.
Disclaimer: This information is intended to provide general guidance and does not provide definitive medical advice. It is not a definitive basis for diagnosis or treatment in any particular case. This material does not cover all information and is not intended as a substitute for professional medical care. It is important that you consult your doctor regarding your specific condition, contraindications and potential complications.