RFA - Radiofrequency Ablation of the Esophagus

Brugsesteenweg

Rumbeke

Torhout

Menen

There has been a change in esophageal tissue in your esophagus. The normal esophageal tissue has been replaced by gastric mucosa that has grown upward into the esophagus. This is called Barrett fabric. Because dysplasia (restless cells) has now developed in this tissue, there is an increased risk of evolution into esophageal cancer. Dysplasia is considered to be a precursor to cancer. A distinction is also made between low-grade dysplasia and high-grade dysplasia. This distinction indicates the degree of unrest in the cells. In high-grade dysplasia, there is more unrest in the cells than in low-grade dysplasia.

This Barrett tissue with dysplasia should therefore be best treated so that the original mucous membrane can recover and there is no further evolution into a cancer. The visible abnormalities are usually first treated endoscopically with EMR (endoscopic mucosal resection) or ESD (endoscopic submucosal dissection) (see specific brochures). If there are no visible lesions, radiofrequency ablation can be treated immediately in case of dysplasia.

Radiofrequency ablation briefly heats the most superficial layer of the esophageal wall using radiofrequency energy, causing this layer to die off, then healing of the esophagus and the original mucous membrane growing back.

At the prior consultation and also before the start of the investigation, report:

any allergies.
heart and/or lung problems.
taking blood thinning medication e.g. aspirin-containing preparations Plavix, Marcoumar, Clopidogrel, Ticlid, Xarelto, Pradaxa, Eliquis, Brilique, Marevan, Sintrom... Blood thinning medication may have to be stopped in time, always in consultation with the doctor.
intake of anti-inflammatory drugs.

Aim of the research

Preparation

An infusion will be placed in the room and you will be asked to remove your glasses/contact lenses and dental prosthesis. A patient apron will be ready for you to wear.
We ask female patients to take off their bra.
You must be sober at least 6 hours before the exam. This means no eating, drinking or smoking.

Execution

This procedure is performed in the endoscopy department under general anesthesia. If this has not happened in the department yet; the nurse will puncture a vein in the arm so that the anaesthetist can administer the anaesthetic.

During the procedure, lie on your left side with a mouthpiece between the teeth/lips to avoid biting the endoscope.
The anaesthetist places a tube in the airway to take over your breath.
During the study, the oxygen level in the blood is continuously measured. This is done with a measuring device that is placed on the finger. You will also receive oxygen glasses on the nose.

The treatment

RFA Balloon Treatment (HALO 360)

A treatment balloon is inserted into the esophagus via an endoscope. A thin metal wire is wrapped around this balloon that gives off the heat. The RFA balloon is heated for approximately 1 second so that the superficial mucosal layer (the Barrett mucosa) is heated. Depending on the length of the Barrett zone, the balloon is moved and heated again until the entire Barrett zone has been treated. After that, the balloon is removed, after which the treated area is cleaned and the heated/dead cells are removed. After that, the procedure with the balloon is repeated again.

RFA treatment with device (Halo 90 — Halo 60)

If the wounds have healed after the first treatment with the RFA balloon, small islands of Barrett's mucosa are usually still present. To treat these remaining spots, an ablation device is attached to the endoscope. This device also has a metal wire that emits heat. The doctor brings the device to the areas to be treated, after which this area is heated. Once all areas have been treated, the area is cleaned back and the procedure is repeated. The total treatment usually takes less than 1 hour. But in most cases, multiple treatment sessions are necessary.

After the examination, you will be taken to the awakening room of the endoscopy department. There, the oxygen level in the blood is further monitored.
A raw feeling in the throat is possible for some time. Chest pain in the first few days is also possible.
Sometimes a fever occurs in the first 24 hours after the procedure. This is often a normal reaction after surgery. This will of course be monitored by your doctor.
After this procedure, you will usually be admitted overnight.
On the day of the procedure, you should only take water or only strictly liquid food. In principle, from the second day, you can switch to soft food. From the tenth day, you can eat perfectly normally.
In case of high fever, unsustainable pain, inability to swallow or loss of blood (vomiting or anal bleeding), you should contact the department or doctor who treated you.

Hospitalization

After the examination

Advantages and disadvantages

Side effects

Points of interest

Risks of this study

An RFA causes a type of superficial burn in the esophagus. The risk of complications is very small. Apart from throat irritation and pain behind the breastbone, patients usually have no complaints after treatment.
Severe inflammation of the esophagus with formation of ulcers and constriction, a small hole in the esophagus (perforation), bleeding, or damage to the throat or esophagus may occur rarely.