A procedure that uses radio frequency (RF) energy delivered to a specific area in the esophagus to destroy Barrett's cells.
What is a Halo procedure?
Halo is a procedure that uses radio frequency (RF) energy delivered to a specific area in the esophagus where Barretts esophagus exists. Barrett's Esophagus is a condition in which the esophagus changes so that some of the esophageal lining is replaced by a type of tissue similar to that normally found in the intestine. This change can sometimes lead to cancer of the esophagus.
During the Halo procedure, RF energy will destroy the Barretts cells without destroying the normal tissue in the deeper layers of the esophagus. The esophagus is expanded by a balloon and the RF energy heats the Barrett's cells and destroys them allowing healthy new tissue to grow in place.
What should I expect during the Halo procedure?
Plan to spend up to 2 hours at the endoscopy center. The procedure itself takes about 30 to 60 minutes to complete.
Before the procedure:
Your medical history will be reviewed with you by your health care team including a nurse, your gastroenterology physician and an anesthesia provider. An IV line will be placed.
During the procedure:
During your procedure, the anesthesia provider will administer medications and monitor vital signs which is a process known as Monitored Anesthesia Care (MAC). While most patients sleep through the procedure, some remain awake and aware. The anesthesiologist and/or certified registered nurse anesthetist (CRNA) will help determine the appropriate type of drug to be used during the procedure to keep you safe and comfortable. The doctor will carefully advance a flexible, hollow tube, called an endoscope, through your esophagus to the area of the abnormal Barrett's cells. You may have a feeling of pressure or fullness. The Halo device will be passed through the endoscope to treat the Barrett's cells. Once abnormal cells are eliminated, healthy new tissue will grow in its place.
What should I expect after the procedure?
The physician will talk with you about the initial results of your procedure and will prepare a full report for the healthcare provider who referred you for your upper endoscopy. You may have some bloating after the procedure which is normal. Your throat may feel sore for a short time. You may also experience mild chest pain or nausea for two to three days. This is normal. Any tissue samples or polyps removed during the procedure will be sent to a lab for evaluation. It may take 5-7 working days for you to be notified of the results by mail or through the Patient Portal.
You may resume most of your regular activities the day after the procedure. However, medication given during the procedure will prohibit you from driving for the rest of the day. Diet instruction will be discussed with you before you leave the endoscopy center. A liquid diet may be recommended for one to two days following the procedure. You should avoid sharp-edged food (such as chips, nuts, popcorn, croutons, etc.) during this time.
Are there possible complications from an Halo procedure?
Although serious complications are rare, any medical procedure has the potential for risks. Risks from an upper endoscopy include perforation, or a tear, of the lining of the stomach or esophagus, bleeding from a biopsy site, reactions to medications, heart and lung problems, and dental or eye injuries.
How many treatment sessions will I need an over what time frame?
Most people need two or three Halo treatment sessions to achieve a cure over a four to twelve month time period until there is no more visible Barrett’s esophagus.. Some people will need more, some less. Your doctor will then take biopsy samples of your esophagus, similar to previous surveillance endoscopies you may have had to monitor your Barrett’s esophagus. This is to confirm that your Barrett’s esophagus is gone.
What are the cure rates?
In the peer-reviewed medical literature, published cure rates of Barrett’s esophagus are 77%-100% with radio frequency ablation (Halo).
How often does Barrett's esophagus come back after Halo treatment?
In a recent study evaluating durability of cure in Barrett’s esophagus patients who had undergone Halo treatment, 92% of patients remained cured at 5 years. Barrett’s esophagus recurred in 8% of the patients. In the patients with recurrent Barrett’s esophagus, the recurrent disease was the same grade as the original (baseline) disease. In other words, there was no disease progression in these patients. It is extremely important to maintain good acid control after Halo treatment. This may be achieved by medications (such as PPIs) or by surgical or endoscopic repair, or a combination of the two. The patients described in the study above continued on acid suppression medication (mostly PPIs) after Halo to prevent Barrett’s esophagus recurrence.
Will I still need to undergo endoscopy (EGD) with biopsy surveillance after undergoing Halo therapy?
Currently, most doctors continue to perform endoscopic biopsy surveillance in patients who have undergone Halo. You should discuss the specific terms of your post-Halo endoscopic biopsy surveillance schedule with your doctor.
Will I still need to take my acid reflux (PPI) medication after undergoing Halo treatment?
Halo treats Barrett's esophagus, not acid reflux. Therefore, your acid reflux will need to be managed after Halo. You and your doctor will decide on the best management strategy based on your individual needs.
Will I still have reflux after undergoing Halo?
Yes. The Halo procedure does not treat acid reflux. Halo treats Barrett’s esophagus, which is a change in the cells that line the esophagus that occurs as a result of chronic acid reflux. So, Halo treats Barrett’s esophagus, but not its cause. You and your doctor will determine the best management for your reflux after undergoing Halo treatment.
For more information:
- http://www.asge.org/PatientInfoIndex.aspx?id=8954 -American Society for Gastrointestinal Endoscopy (ASGE)
- http://www.acg.gi.org/patients/gihealth/barretts.asp -The American College of Gastroenterology (ACG)
Results from any testing will be sent via mail.