Boone Hospital Center home to effective Barrett's esophagus treatment

Thursday, August 6, 2009 | 12:01 a.m. CDT
RF Ablation is a treatment for a precancerous condition known as Barrett’s esophagus. The treatment consists of inserting and then inflating a balloon at the end of a scope within the affected area of the esophagus. A rapid (less than one second) burst of energy removes a very thin layer of the diseased esophagus, allowing healthy underlying tissue to surface.

COLUMBIA — Members of a six man gastro-intestinal group associated with Boone Hospital Center are working to become experts at Radio Frequency Ablation, a treatment for Barrett’s esophagus. The hospital is the only facility in mid-Missouri that offers the treatment; it has conducted 65 procedures since November 2008, spokesman Steve Adams said.

In a study conducted in May, RF ablation was confirmed by the New England Journal of Medicine as 90 percent effective as a treatment for Barrett’s esophagus, which affects 3.3 million Americans a year. Those with Barrett’s esophagus have a 0.5 percent risk of developing cancer per year, said Nicolas Llorens, a gastroenterologist in the group. The procedure has been around for at least two years, he said.

Barrett’s esophagus occurs when the lining of the esophagus has been changed from its normal state to a pre-cancerous state because of repeated acid reflux, Llorens explained.

“First, we pass a sizing balloon to measure the internal diameter of the esophagus,” Llorens explained. “Then, the ablation balloon is inserted, along with a scope that let’s us watch what we’re doing.” They then blow up the balloon and press a pedal which administers a rapid burst of energy, he said. He compared it to briefly microwaving the tissue. The balloon is made out of synthetic plastic.

The treatment kills the affected lining of the esophagus, allowing healthy tissue to surface, Llorens said.

“On average, it takes three to four treatments to eradicate the unhealthy tissue,” Llorens said.

Kevin Heyen of Ashland had his first treatment June 30 and is scheduled for his second Sept. 1. Heyen, after discussing his options with the doctor and doing some research on his own, decided to have the procedure because the risks were fairly minimal.

After receiving the treatment, patients are brought back in within two to three months to see if any of the diseased tissue is left, Llorens said. If there is, then they conduct another ablation.

Side effects include mild to moderate chest pain, bleeding, and, rarely, perforation of the esophagus, Llorens said.

There is also an 8 percent risk of buried glands, Llorens said. When the surface is burned, further surveillance of the affected area is difficult which can cause them to miss diseased glands.

Heyen did not have any complications.

“I really felt great the next day,” he said. “The day after my procedure I went for a two-mile run. In the week following, I ran 20 miles total. … I haven’t had any trouble and we don’t know until I go through the second procedure, but hopefully after that they will have ablated all of it.”

“RF ablation is far more effective than photo-dynamic therapy, the previous treatment for Barrett’s esophagus,” Llorens said. In photo dynamic therapy, a doctor goes sprays a chemical down the esophagus that reacts to a particular wavelength. When that wavelength is applied to the chemical, the chemical is activated causing a chemical burn, Llorens explained. It is not as affective a treatment because it misses more spots and can cause skin changes from outside exposure.

The cost of the procedure is dependent on an individual treatment plan, and most insurance companies provide individual coverage for the treatment, said Steve Adams, spokesman for Boone Hospital Center. The hospital was unable to give a price range for the procedure.

Llorens was unsure of uses for RF ablation technology in other medical areas, but he said using it for other gastro-intestinal procedures is only theoretical at this point.

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