Barrett’s esophagus (BE) or intestinal metaplasia (IM) is a visible change in the normal lining (or mucosa) of the esophagus (the muscular tube that transfers food from the throat to the stomach). The diagnosis is suspected visually at the time of upper endoscopy (see upper endoscopy tab for details) and confirmed by biopsy (samples) of the suspicious mucosa. BE develops as a result of chronic exposure of the esophagus to stomach acid, enzymes and bile, collectively known as gastroesophageal reflux disease (GERD). Patients with reflux disease present with symptoms of heartburn and regurgitation. Risk factors may include the presence of a hiatal hernia, a condition that renders the lower esophageal sphincter (muscle valve) less competent in preventing gastroesophageal reflux.
Barrett’s esophagus increases the risk of esophageal cancer. Once Barrett’s esophagus is detected at the time of initial upper endoscopy, periodic surveillance and biopsies of this abnormal mucosa is recommended. Before cancer develops from Barrett’s esophagus, a pre-cancerous condition called high grade dysplasia (HGD) can be detected by biopsies of Barrett’s esophagus. Since HGD will likely lead to esophageal cancer, elimination (ablation) of this condition will likely prevent the development of cancer.
One of techniques used to achieve this goal is called radiofrequency ablation (RFA). This endoscopic technique provides a controlled-depth burn of Barrett’s esophagus which results in its elimination. The HALO system (previously Barrx®) is the most advanced and commonly used system for this purpose.
The ablation catheter or devise can be circumferential (HALO360) or a quarter of a circle (HALO90). Your physician will decide on the proper devise to use based on the length and extension of Barrett’s esophagus. This will not change what you should expect during or after the procedure.
The preparation and recovery for the procedure are not different from those for upper endoscopy (see upper endoscopy tab) but the duration of the procedure is longer.The procedure is done on an outpatient basis under general anesthesia at Tampa General Hospital GE (GastroEnterology) Center.The potential risks of the procedure are not different from those mentioned for upper endoscopy, but chest pain and difficulty swallowing may also occur. Also, a stricture (narrowing) of the esophagus and fluid build-up around the lung(s) has also been reported. Your doctor will prescribe you with pain medications if necessary and may ask you to be on liquid diet for 2-3 days afterwards.
After the initial procedure, surveillance endoscopies are needed to monitor the results of the treatment and the decision to repeat the procedure in the future.