Treatment for Barrett’s oesophagus promising

Acid reflux, often dismissed by many as a minor inconvenience when pondering the enticing prospect of a spicy salsa or curry dish, can come back to bite you – literally.

Even the arsenal of little pastel "anti-burp" tablets readily available at convenience stores is no match for the acid’s assault on the oesophagus that can lead to pain, erosion of tissue and future complications. Left untreated, repeated bouts of acid reflux can result in chronic gastro-oesophageal reflux disease (GORD), characterised by heartburn – a gnawing, burning sensation often experienced at night or after eating.

In a more serious form, a daily history of GORD can lead to Barrett’s oesophagus, a pre-cancerous condition of the lining of the oesophagus. Traditionally, patients with Barrett’s oesophagus were managed with aggressive surveillance.

Now a treatment for Barrett’s oesophagus in patients with dysplasia (abnormal cells within tissue that are a signal for progression to possible cancer) is showing promise. According to the Mayo Clinic gastroenterologists who studied and treated 63 patients with both low-grade and high-grade dysplasia, ablation – a procedure where a localised heat treatment is used to destroy abnormal cells – appears to be a safe and effective intervention.

Low-grade dysplasia is evidenced by smaller, pre-cancerous changes in cells. High-grade dysplasia is diagnosed when the most advanced pre-cancerous changes are observed.

The study, led by Virender K. Sharma, MD, Gastroenterology, Mayo Clinic in Arizona, enrolled the 63 patients with dysplasia and treated them with radio frequency ablation, using the HALO system, developed by BARRX Medical. The two-pronged system, one called "circumferential ablation" and the second, "focal ablation", directly targets the abnormal oesophageal tissue.

The circumferential ablation (HALO 360) procedure uses a sizing balloon, ablation catheter and an energy generator. The focal ablation (HALO 90) uses an endoscope that brings an electrode into contact with the targeted tissue. Bursts of energy destroy the diseased tissue.

When the final results were tallied on the 62 patients who were eligible at a median 24 months of follow-up, there was a complete response for dysplasia in 95 percent and 79 percent of patients with low-grade dysplasia and high-grade dysplasia, respectively. It was determined that the circumferential and focal ablation methods employed to treat Barrett’s oesophagus with dysplasia appeared to be an effective and safe intervention, according to Dr Sharma.

The procedures are minimally invasive and are done on an outpatient basis, allowing patients to go home the same day.

"This study is an important advance for gastrointestinal medicine because it was able to demonstrate a real-life experience for the management of Barrett’s oesophagus for patients with low and high-grade dysplasia," notes Dr Sharma. He calls for further evaluation of these ablative procedures and adds, "Because of the ease of use, the relative low cost and lack of significant side effects, we have compelling reasons to study and use this treatment."

The incidence of Barrett’s oesophagus is rising rapidly in the US and is estimated to affect some 3.3 million adults. Men are at greater risk and the prevalence of Barrett’s increases with advancing age until a plateau is reached in the 60s. Patients with Barrett’s oesophagus are 30 to 125 times more likely to develop oesophageal cancer than the general population.

The Mayo Clinic oesophageal physicians from the Division of Gastroenterology perform cutting-edge therapeutic procedures in Barrett’s patients. "We not only have the largest experience of using the HALO in Barrett’s, but also we are spearheading the investigation of a new ablative technique, cryotherapy, in these patients," said the director of oesophageal clinic, H. Jae Kim, MD. "These techniques may have a significant impact on reducing the incidence of oesophageal cancer by ablating the pre-cancerous lesion, Barrett’s oesophagus. The initial results for cryotherapy appear promising, and we are currently involved in the large multicentre study," adds Dr Kim.

(Source: Mayo Clinic: American Journal of Gastroenterology: March 2009)