2009 News Stories

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HALO ablation catheter attached to an endoscopeAn increasingly common precancerous condition called Barrett’s esophagus can lead to a deadly cancer called esophageal adenocarcinoma, which has a very low survival rate. Barrett's esophagus is caused by chronic GERD (gastroesophageal reflux disease). In Barrett's esophagus, cells have undergone genetic changes that leave them vulnerable to further changes that can lead to cancer. A new treatment available at The Queen's Medical Center may turn the tide on Barrett's esophagus, and hence esophageal adenocarcinoma rates in Hawai’i.

Currently, about 44 percent of U.S. adults experience the symptoms of GERD almost monthly, while 18 percent have them weekly. Prolonged GERD has led to Barrett's esophagus in approximately 3.3 million Americans. The frequency of esophageal adenocarcinoma is on the rise, increasing six-fold from 1975 to 2001 in the U.S., making it the fastest growing form of cancer in America.

Until now, the standard treatment for Barrett's esophagus has been "watchful waiting," with upper endoscopies and biopsies every three months to three years to evaluate the progression of the disease. These procedures require a visit to a hospital, anesthesia, several days of recovery and eating restrictions. Certain types of advanced Barrett's and adenocarcinoma require removal of the esophagus, which has significant risks and a long recovery period. After removal of the esophagus, about 20 percent of patients may have a poor quality of life with swallowing problems, decreased food intake, hoarseness, reflux and diarrhea. The five-year survival rate for adenocarcinoma is just 17 percent.

A Sizing BaloonThe new treatment for Barrett's esophagus uses uniform and controlled ablation (the use of energy to remove cells), eliminating Barrett's tissue and allowing the regrowth of normal cells. The FDA-approved equipment, called the HALO System, is available at Queen's. "It's an alternative to major surgery," says Chris Aoki, MD, "and a way to [substantially reduce the risk] of getting cancer in the first place." Dr. Aoki explained that patients are placed under conscious sedation for the procedure, which uses a rapid burst of radio frequency ablation to remove a thin layer of abnormal tissue without injury to healthy underlying tissue. Healthy tissue replaces ablated tissue in three to four weeks in most patients. Several clinical trials have demonstrated that 98 percent of participants were Barrett's-free after one or two HALO treatments after two and a half years. A recent randomized controlled trial with 127 patients published in the May 2009 New England Journal of Medicine reported that the HALO System eliminated a high rate of Barrett's esophagus in all stages, and that the patients had a significantly lower rate of progressing to cancer.

 

Photo Captions:

1. Chris Aoki, MD, shows a HALO ablation catheter attached to an endoscope. Behind him is a monitor  which projects an image from the endoscope.

2. A sizing balloon is first used to size the patient’s esophagus. Then a correctly sized ablation catheter is inflated at the treatment area. An energy generator is activated to deliver a rapid burst of ablative energy.

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