New procedure helps prevent esophageal cancer

Additional facts About 20 million Americans have GERD every day. (Gastroenterologists see a large increase of acid-reflux patients; they say the trend follows the epidemic of obesity. The CDC estimates two-thirds of adults are overweight and one-third are obese.) About one in 10 heartburn patients will develop a precancerous complication of GERD called Barrett’s esophagus. Barrett’s esophagus is estimated to affect approximately 3.3 million adults older than 50 years of age in the United States. Patients with Barrett’s esophagus are 20 to 125 times more likely to develop adenocarcinoma (esophageal cancer) than the general population. The incidence of esophageal cancer has risen approximately six-fold in the United States. It is rising faster than breast cancer, prostate cancer or melanoma. Esophageal cancer has a dismal prognosis, more than 90 percent of patients die within five years of the diagnosis.

Eat, drink and be merry — that’s how many like to have a good time.

Fun for most people, but for those with chronic heartburn or GERD (gastroesophageal reflux disease), eating can translate into real misery. It is a problem plaguing about one in five adults.

In addition, there is an even greater concern for those adults with GERD. Doctors say the acid-reflux disease can develop into Barrett’s esophagus, a precancerous condition affecting the lining of the esophagus (the muscular tube that carries food, liquids and saliva from the mouth to the stomach).

Left untreated, Barrett’s esophagus can lead to a dangerous type of cancer called esophageal adenocarcinoma, which is currently the most rapidly rising cancer in the United States.

Fortunately, a new procedure for treating Barrett’s esophagus is available in the state of Nebraska.

UNMC’s hospital partner, The Nebraska Medical Center, offers the BARRX Medical HALO ablation technology, which removes the diseased layer of cells from the esophagus and offers treatment of the disease before it has the chance to progress to cancer.

“This is the best therapy available for treating patients with Barrett’s esophagus,” said Ed Schafer, M.D., clinical assistant professor of internal medicine at UNMC and a gastroenterologist at The Nebraska Medical Center. “It is a low risk procedure in comparison to the other therapies like cryotherapy, photodynamic therapy and argon plasma coagulation.

“With these therapies, while burning away tissue, it is impossible to control the depth of the burn. The HALO ablation technology allows a refined and controlled burn.”

Grant Hutchins, M.D., assistant professor of internal medicine at UNMC and a gastroenterologist at The Nebraska Medical Center agreed.

“The other therapies can have significant complications and in some cases leave residual Barrett’s,” he said.

Dr. Schafer added that the HALO ablation technology is an easier technique and less time consuming for patients compared to the other therapies.

“For example, photodynamic therapy requires five to six treatments and the patient has to wear sunglasses constantly during the month of treatment to protect his or her skin from bright light,” he said.

The HALO ablation treatment makes use of an electrode mounted on the end of an endoscope, the instrument used to examine the gastrointestinal tract. The electrodes ablate or burn away the tissues associated with Barrett’s esophagus.

“This is the best therapy available for treating patients with Barrett’s esophagus.” Ed Schafer, M.D.

Once the diseased Barrett’s tissue has been removed using the HALO treatment, new, healthy tissue grows back, replacing damaged tissue within three to four weeks.

“Before we had a technique like this, many patients with Barrett’s esophagus in its advanced stage required surgery and the surgery generally involved removing a significant portion of your esophagus or most of your esophagus,” Dr. Hutchins said. “Patients never really ate normally again and are plagued with post-surgical swallowing difficulty.”

With HALO, a large percentage of patients are cured of Barrett’s and are spared surgery, he said.

The HALO is an outpatient treatment that takes about 60 minutes. The device was cleared by the U.S. Food and Drug Administration in 2001 and became commercially available in January 2005.

Drs. Schafer and Hutchins do not recommend the HALO treatment for every patient with Barrett’s esophagus, only for patients with dysplasia cells (abnormal growth of cells that could be cancerous) and those with a family history of esophageal cancer.

While HALO cures the condition of Barrett’s esophagus, the acid-reflux is still a problem. Doctors can generally manage the acid reflux with medications and lifestyle changes.