Gastroenterology - Ablation therapy for Barrett’s Oesophagus – Radiofrequency ablation (heat) or cryoablation (cold)

Why you have this leaflet

This leaflet is to help you understand a treatment called Radiofrequency Ablation (RFA) or cryoablation. These are used to treat and stop abnormal cells in the oesophagus (food pipe) from becoming cancer. These cells can appear if you have a condition called Barrett’s oesophagus.

What is Barrett’s oesophagus?

Barrett’s oesophagus happens when acid from your stomach keeps coming up into your food pipe. Over time, this can change the normal lining of your food pipe and may increase the chance of getting cancer.

To check for changes early, people with Barrett’s usually have regular checks with a camera test (called an endoscopy) and small tissue samples (biopsies).

You are getting this leaflet because abnormal cells (called dysplasia) have been found in your food pipe, or you have had early signs of cancer removed. The doctor now wants to treat the rest of the Barrett’s to stop more problems.

What is Ablation?

Ablation is a treatment that uses heat or cold to remove the abnormal cells in your food pipe.

A thin, flexible tube (an endoscope) with a special heat pad or balloon (cryoablation) is passed down into your food pipe. The heat from radio waves or a cold gas are used to burn away the abnormal cells. After a few treatments, the hope is your food pipe will heal with healthy cells, and your cancer risk will be much lower.

VanMunster et al Gastrointest Endosc. 2018 Nov;88(5):795-803.e2. doi: 10.1016/j.gie.2018.06.015. Epub 2018 Jun 19. PMID: 29928869

How many treatments will I need?

You will have your first treatment, then return in about 3 months to check how things are healing. Most people need up to 4 or 5 treatments.

After your Barrett’s has been cleared, you will still need regular check-ups, but these will happen less often.

How can I help the treatment work well?

• Take all the medicines your doctor gives you to reduce stomach acid (like omeprazole, famotidine, or sucralfate)
• Avoid things that make acid reflux worse (like spicy food, smoking, or alcohol)
• Try to stay a healthy weight

Before the treatment

• You will talk to a doctor who will explain the procedure and its risks
• You will need to stop eating and drinking for a few hours before the test
• If you take blood-thinning medicine, you might need to stop it - your doctor will advise you
• You will have sedation (a medicine to make you sleepy), so someone must take you home and stay with you for 24 hours
• Do not drive, work, sign papers, or be alone for 24 hours after the treatment

What happens during the treatment?

• A nurse will ask about your health and put a small needle (called a cannula) in your arm for sedation
• You will meet the doctor again and sign a consent form
• You’ll be taken to the treatment room, where:
  ○    You’ll get a spray to numb your throat
  ○    You’ll be given sedation through the cannula
  ○    The endoscope will be passed into your food pipe and stomach
  ○    The doctor will check the area and then treat it with RFA
• Sometimes other treatments may be done at the same time, such as:
  ○    Balloon dilation (to stretch any narrowed areas)

Will it hurt?

• The treatment itself is not painful
• Afterwards, you might feel a sore throat or chest pain. This is usually mild and can be treated with painkillers
• You will be told what to do if your pain gets worse

After the treatment

• You’ll stay in the department for up to 2 hours to make sure you’re okay
• You’ll get medicine to lower stomach acid to help healing
• You’ll get another appointment in about 3 months to check how things are going and whether more treatment is needed

Risks of the Treatment

Risks from the endoscopy (camera test):

• Sore throat (may last up to a week)
• Damage to teeth or dentures (dentures will be removed first)
• Bloating or discomfort
• Small risk of damage (tear or hole) in your food pipe or stomach
• Bleeding

Risks from ablation therapy:

Pain

• Most people get mild pain that settles with painkillers
• If pain is very bad or not going away, get medical help

Scarring (Stricture)

• About 10–15% of people may get scarring that makes swallowing harder
• This can be treated with balloon dilation

Perforation (Hole in the food pipe or stomach)

• Rare (1–2% of people)
• You might need medicine, a stay in hospital, or sometimes surgery to fix it

Bleeding

• Rare (1–2%)
• Can happen during the procedure or a few days later
• Watch out for:
  ○    Vomiting blood
  ○    Black poo
  ○    Contact a doctor straight away if these happen

Sedation reactions

• Some people feel unwell with sedation
• This can be treated during the procedure if needed

Need for more treatments

• Most people will need a few ablation treatments
• Everyone will have follow-up endoscopies to check for any further problems in the food pipe

Going Home

Eating and drinking

• Nothing to eat or drink for 1 hour after the treatment
• Then drink clear fluids for 2 hours
• After that, eat soft foods only for 5 days
• Swallowing should start to feel easier after 7 to 14 days
• If it becomes harder to swallow, contact your healthcare team

When to seek urgent medical help

Call for medical help straight away if you:

• Have a high temperature (fever)
• Vomit blood or have black poo
• Get strong chest pain
• Notice swelling in your neck or chest

Follow-up and next steps

• You will be seen every 3 months until the Barrett’s is treated usually 2-4 treatments
• The hospital team will keep in touch to check how you are doing

If you have any questions at any time you may contact:

• Kerry Quinn Upper GI clinical nurse specialist on 07873 704349 or
• The secretaries involved in your care - 0161 206 5671