RFA - Radiofrequency Ablation of the Esophagus

A change has occurred in the tissue of your esophagus. The normal esophageal tissue has been replaced by stomach lining that has grown upward into the esophagus. This is called Barrett’s esophagus. Because dysplasia (abnormal cells) has since developed in this tissue, there is an increased risk of progression to esophageal cancer. Dysplasia is considered a precancerous condition. A distinction is also made between low-grade dysplasia and high-grade dysplasia. This distinction indicates the degree of abnormality in the cells. In high-grade dysplasia, there is a greater degree of abnormality in the cells than in low-grade dysplasia.

Consequently, this Barrett’s esophagus with dysplasia should be treated appropriately so that the original mucosa can heal and the condition does not progress to cancer. Visible abnormalities are usually treated first endoscopically using EMR (endoscopic mucosal resection) or ESD (endoscopic submucosal dissection) (see specific brochures). If there are no visible lesions, radiofrequency ablation can be used immediately to treat dysplasia.

In radiofrequency ablation, the outermost layer of the esophageal wall is briefly heated using radiofrequency energy, causing this layer to die off; the esophagus then heals, and the original mucosa regrows.

Please report the following during the preliminary consultation and also before the start of the investigation:

• any allergies.
• heart and/or lung problems.
• Taking blood-thinning medication, such as aspirin-containing preparations like Plavix, Marcoumar, Clopidogrel, Ticlid, Xarelto, Pradaxa, Eliquis, Brilique, Marevan, Sintrom… Blood-thinning medication may need to be discontinued in a timely manner, always in consultation with your doctor.
• taking anti-inflammatory medications.

• An IV will be inserted in your room, and you will be asked to remove your glasses, contact lenses, and dentures. A patient gown will be provided for you to put on.
• We ask female patients to remove their bras.
• You must fast for at least 6 hours before the test. This means you should not eat, drink, or smoke.

This procedure is performed in the endoscopy unit under general anesthesia. If this has not already been done in the unit, the nurse will insert an IV into a vein in your arm so that the anesthesiologist can administer the anesthesia through it.

• During the procedure, you will lie on your left side with a mouthpiece between your teeth and lips to prevent you from biting the endoscope.
• The anesthesiologist will insert a tube into your airway to take over your breathing.
• During the test, the oxygen level in your blood is measured continuously. This is done using a small device placed on your finger. You will also be given a pair of oxygen goggles to wear over your nose.

The Treatment

RFA Balloon Treatment (HALO 360)

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

RFA treatment using a device (Halo 90 – Halo 60)

Once the small lesions have healed after the initial treatment with the RFA balloon, small patches of Barrett’s esophagus usually remain. To treat these remaining areas, an ablation device is attached to the endoscope. This device also has a metal wire that emits heat. The doctor guides the device to the areas to be treated, after which that area is heated. Once all the areas have been treated, the area is cleaned again, and the procedure is repeated. The entire treatment usually takes less than 1 hour. However, in most cases, multiple treatment sessions are necessary.

• After the procedure, you will be taken to the recovery room in the endoscopy unit. There, your blood oxygen levels will continue to be monitored.
• You may experience a scratchy throat for a while. You may also experience chest pain during the first few days.
• Sometimes a fever may develop within the first 24 hours after the procedure. This is often a normal reaction following the procedure. Your doctor will, of course, monitor this.
• After this procedure, you will usually be admitted for one night.
• On the day of the procedure, you may only drink water or consume strictly liquid foods. Starting on the second day, you can generally switch to soft foods. Starting on the tenth day, you may eat a completely normal diet.
• If you have a high fever, unbearable pain, difficulty swallowing, or bleeding (vomiting blood or rectal bleeding), you should contact the department or the doctor who treated you.

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