Radio-frequency ablation (RFA) for the treatment of Barrett’s oesophagus (BE) related neoplasia ablative intervention after endoscopic resection (ER)For circumferential BE, the 3 cm HALO 360.Introduction
balloon used to treat large areas. A new device, the HALO 360 Express self-sizing catheter was recently launched and can potentially allow quicker ablation times and better coverage of the mucosa due to the improved tissue/catheter contact and 4 cm balloon length. We have previously presented initial data of 3 month follow up in these patients but now present more extensive data including end of treatment biopsies.Method
Specialist centres in the UK and Ireland submitted cases where Halo 360 express had been used. Patients returned for follow up at 3 months after index RFA express treatment. surface area regression of BE regression of intestinal metaplasia (EoT (End of Treatment) CR-IM) and dysplasia (EoT CR-D) were analysed.[MDP1] .Results
11 centres submitted 123 patients treated with the HALO 360 Express catheter. 112 of these cases had 3 month follow up. The mean age was 67 years±10. 83% were male. 43 patients (35%) had low grade dysplasia (LGD) as initial histology; 62 had high grade dysplasia (HGD) 50%, 19 had intramucosal carcinoma (15%), 1 had invasive adenocarcinoma. 54 (44%) had had previous endoscopic mucosal resection (EMR).The mean pre-treatment circumferential Barrett’s segment was 5.5 cm ±4.3 cm and the mean mucosal length (M) was 7.8 cm ±3.6 cm mean% reduction in C of 78%±36% and mean reduction in M of 55%±36% at this first 3 month follow up.Results
17 patients developed strictures which required dilation at this 3 month follow up. The median number of dilations was 2 (IQR2–4). 4/17 (24%) were treated with 12J/no clean, 10/17 were treated with 10J/no clean (59%), 3/17 (17%) had been treated with 10J/clean protocol. 8/17 (47%) had had previous EMR.Results
47 patients had 12 month EoT biopsies, 40 (85%) had CR-D and 34 (76%) had CR-IM. 4/112 patients (<4%) had progressed to invasive cancer at the time of writing. The median number of treatments (focal RFA, EMR, APC (argon plasma coagulation)) to EoT was 2(IQR1–4).Conclusions
The HALO 360 Express catheter shows good reduction in C and M length at 3 months, and effective eradication of IM and Dysplasia in those at 12 months. However, as previously reported by us the stricture rate is high.