Barrett’s Oesophagus is a serious complication of gastroesophageal reflux disease (GORD). It leads to changes in the lining of the oesophagus – the tube that carries food from the mouth to the stomach – which comes to resemble the lining of the intestines. Although the symptoms of Barrett’s Oesophagus are similar to GORD, the condition increases the risk of developing cancer of the oesophagus.
For this reason, if you have been diagnosed with Barrett’s Oesophagus, it is important to undergo regular routine examinations of your oesophagus so your doctor can find and treat any precancerous and cancerous cells early on while they are more responsive to treatment.
Our stomachs produce acid to digest food. The oesophagus is designed to be protected against this acid by a ring of muscle at the end of the oesophagus where it joins the stomach.
With GORD, stomach acid flows upwards into the oesophagus – a process known as reflux. This causes symptoms such as heartburn, a sour, burning sensation in the back of the throat and nausea.
Endoscopic eradication therapy is frequently used to treat the precancerous changes in the cells of the oesophagus (known as dysplasia) as well as early stage oesophageal cancer.
It is a developing treatment that is subject to ongoing research and clinical studies so therefore it is too early to tell how this treatment performs over the longer-term.
Endoscopic ablation is a minimally invasive procedure that removes diseased cells in the mucosal layer of the oesophagus. Radio frequency ablation (RFA) works by using heat from radio waves to kill cells.
- Radio frequency – is a type of electrical energy
- “Ablation” – meaning to complexly destroy
If you have high grade Barrett’s oesophagus, where the cells looks very abnormal under a microscope, then your doctor may suggest you have RFA either on its own or in combination with other treatment.
What to expect from the treatment
RFA for Barrett’s Oesophagus is provided as an outpatient, meaning you don’t need to stay in hospital. A general anaesthetic or strong sedative combined with a local anaesthetic is required in advance of the treatment.
You will be required to not eat or drink anything after midnight prior to the treatment.
During the treatment, heat energy is applied directly to the diseased part of the oesophagus via an electrode, mounted on a balloon catheter, or an endoscope, which is a thin, flexible tube.
The treatment takes approximately 30 minutes and typically one to three treatments are required to remove the diseased tissue.
Effectiveness of treatment
Recent research shows that endoscopic ablation is effective at eradicating precancerous cells, although Barrett’s Oesophagus can sometimes recur, particularly at the point where the oesophagus joins the stomach.
Risk factors associated with treatment include extended segments of Barrett’s Oesophagus and persistent reflux.
RFA is most effective in high grade dysplasia and in younger patients or those with multifocal disease.
Side effects include chest pain, which can be managed with oral painkillers. Less common side effects include bleeding and perforation.
Overall, endoscopic therapies for Barrett’s Oesophagus are shown to have a good success rate. Studies are now taking place into combining different therapeutic treatments, such as radiofrequency ablation and endoscopic mucosal resection.
It is particularly important to match the right technique to the right patient profile as this makes a difference to the outcome. It is important, too, for patients to receive regular endoscopic surveillance after any kind of ablation treatment.